Cardiology Department, University of Texas Health Science Center, San Antonio, Texas.
Internal Medicine Department, Lahey Hospital and Medical Center, Burlington Massachusetts.
Am J Cardiol. 2024 Jul 1;222:175-182. doi: 10.1016/j.amjcard.2024.04.032. Epub 2024 Apr 30.
Anthracyclines are pivotal in cancer treatment, yet their clinical utility is hindered by the risk of cardiotoxicity. Preclinical studies highlight the effectiveness of sodium-glucose cotransporter-2 inhibitors (SGLT2i) in mitigating anthracycline-induced cardiotoxicity. Nonetheless, the translation of these findings to clinical practice remains uncertain. This study aims to evaluate the safety and potential of SGLT2i for preventing cardiotoxicity in patients with cancer, without preexisting heart failure (HF), receiving anthracyclines therapy. Using the TriNetX Global Research Network, patients with cancer, without previous HF diagnosis, receiving anthracycline therapy were identified and classified into 2 groups based on SGLT2i usage. A 1:1 propensity score matching was used to control for baseline characteristics between the 2 groups. Patients were followed for 2 years. The primary end point was new-onset HF, and the secondary end points were HF exacerbation, new-onset arrhythmia, myocardial infarction, all-cause mortality, and all-cause hospitalization. Safety outcomes included acute renal failure and creatinine levels. A total of 79,074 patients were identified, and 1,412 were included post-matching (706 in each group). They comprised 53% females, 62% White, with a mean age of 62.5 ± 11.4 years. Over the 2-year follow-up period, patients on SGLT2i had lower rates of new-onset HF (hazard ratio 0.147, 95% confidence interval 0.073 to 0.294) and arrhythmia (hazard ratio 0.397, 95% confidence interval 0.227 to 0.692) compared with those not on SGLT2i. The incidence of all-cause mortality, myocardial infarction, all-cause hospitalization, and safety outcomes were similar between both groups. In conclusion, among patients with cancer receiving anthracycline therapy without preexisting HF, SGLT2i use demonstrates both safety and effectiveness in reducing anthracycline-induced cardiotoxicity, with a decreased incidence of new-onset HF, HF exacerbation, and arrhythmias.
蒽环类药物在癌症治疗中具有重要作用，但由于其存在心脏毒性的风险，限制了其临床应用。临床前研究强调了钠-葡萄糖共转运蛋白 2 抑制剂（SGLT2i）在减轻蒽环类药物引起的心脏毒性方面的有效性。然而，这些发现转化为临床实践仍然存在不确定性。本研究旨在评估 SGLT2i 在预防无预先存在心力衰竭（HF）的癌症患者接受蒽环类药物治疗时发生心脏毒性的安全性和潜力。利用 TriNetX 全球研究网络，确定了无先前 HF 诊断、接受蒽环类药物治疗的癌症患者，并根据 SGLT2i 的使用情况将其分为 2 组。采用 1:1 倾向评分匹配来控制两组间的基线特征。对患者进行了 2 年的随访。主要终点是新发心力衰竭（HF），次要终点是 HF 恶化、新发心律失常、心肌梗死、全因死亡率和全因住院率。安全性结局包括急性肾衰竭和肌酐水平。共确定了 79074 名患者，匹配后纳入了 1412 名患者（每组 706 名）。他们包括 53%的女性，62%为白人，平均年龄为 62.5±11.4 岁。在 2 年的随访期间，接受 SGLT2i 治疗的患者新发 HF（风险比 0.147，95%置信区间 0.073 至 0.294）和心律失常（风险比 0.397，95%置信区间 0.227 至 0.692）的发生率低于未接受 SGLT2i 治疗的患者。两组间全因死亡率、心肌梗死、全因住院率和安全性结局相似。总之，在无预先存在 HF 的接受蒽环类药物治疗的癌症患者中，SGLT2i 的使用在降低蒽环类药物引起的心脏毒性方面具有安全性和有效性，新发 HF、HF 恶化和心律失常的发生率降低。
