Lou Yake, Yang Qi, Zhang Weicong, Yu Ying, Huang Jing
Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, 400010 Chongqing, China.
Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, 400016 Chongqing, China.
Rev Cardiovasc Med. 2022 Oct 31;23(11):374. doi: 10.31083/j.rcm2311374. eCollection 2022 Nov.
Heart failure is prevalent worldwide. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are effective in heart failure patients with reduced ejection fraction, whether SGLT2i are effective in heart failure with preserved ejection fraction (HFpEF) remains to be determined.
All relevant citations in the PubMed, Embase and Cochrane databases were identified from inception to September, 2022. The primary outcome was a composite endpoint of cardiovascular death and hospitalization for heart failure (HHF). A subgroup analysis was performed according to diabetes mellitus status and the ejection fraction. Secondary endpoints were cardiovascular death, hospitalization for heart failure and all cause death.
Seven studies involving 11,604 patients were included in the meta-analysis. Compared with placebo, sodium-glucose cotransporter 2 inhibitors reduced the incidence of the primary outcome by 24%, with an odds ratio (OR) and 95% confidence interval (CI) 0.76 [0.69, 0.84]. For secondary outcomes, sodium-glucose cotransporter 2 inhibitors were associated with a lower incidence of hospitalization for heart failure, but not cardiovascular or all-cause death; the OR and 95% CI were 0.73 [0.66, 0.82], 0.92 [0.81, 1.04], 0.96 [0.88, 1.05], respectively.
This study proves the clinical efficacy of SGLT2i for treatment of HFpEF patients with or without diabetes, which was mainly driven by prevention of HHF rather than cardiovascular or all-cause death.
心力衰竭在全球范围内普遍存在。钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）对射血分数降低的心力衰竭患者有效，但其对射血分数保留的心力衰竭（HFpEF）患者是否有效仍有待确定。
检索了PubMed、Embase和Cochrane数据库从建库至2022年9月的所有相关文献。主要结局是心血管死亡和因心力衰竭住院（HHF）的复合终点。根据糖尿病状态和射血分数进行亚组分析。次要终点为心血管死亡、因心力衰竭住院和全因死亡。
荟萃分析纳入了7项研究，共11604例患者。与安慰剂相比，钠-葡萄糖协同转运蛋白2抑制剂使主要结局的发生率降低了24%，比值比（OR）及95%置信区间（CI）为0.76 [0.69, 0.84]。对于次要结局，钠-葡萄糖协同转运蛋白2抑制剂与较低的因心力衰竭住院发生率相关，但与心血管死亡或全因死亡无关；OR及95%CI分别为0.73 [0.66, 0.82]、0.92 [0.81, 1.04]、0.96 [0.88, 1.05]。
本研究证明了SGLT2i治疗有或无糖尿病的HFpEF患者具有临床疗效，这主要是通过预防HHF而非心血管死亡或全因死亡实现的。
