Lin Miao, Zhang Shiyu, Zhang Lu, Yang Chengying, Luo Yang, Peng Yajin, Tan Xiaoqiu, Wen Qiang, Fan Xinrong, Ou Xianhong
Key Laboratory of Medical Electrophysiology of the Ministry of Education, Medical Electrophysiological Key Laboratory of Sichuan Province, Institute of Cardiovascular Research, Southwest Medical University, Luzhou, China.
Department of Cardiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
Syst Rev. 2025 Feb 1;14(1):31. doi: 10.1186/s13643-025-02766-7.
Sodium-glucose co-transporter 2 (SGLT2) inhibitors have been shown to lower the risk of re-hospitalization and cardiovascular mortality among heart failure (HF) patients. Nevertheless, the impact of these agents on ventricular arrhythmias (VAs) has not been thoroughly investigated. To assess the beneficial impact of SGLT2 inhibitors on VAs in patients at various stages of HF, a systematic review and meta-analysis of randomized controlled trials involving SGLT2 inhibitors in this patient population was performed.
A comprehensive search of the PubMed, Embase, Ovid, ProQuest, Scopus, and Cochrane databases was performed for clinical trials published up to November 21, 2024. The primary outcomes of interest were incidences of VAs and sudden cardiac death (SCD) between the groups receiving SGLT2 inhibitors and the control drugs. For the outcomes observed in the populations of the included trials and in specific subgroups, hazard ratios (HRs) and 95% confidence intervals (CIs) were pooled and meta-analysed across the analyses.
A total of 23 randomized trials (22 placebo-controlled trials and 1 active-controlled trial) involving 74,380 patients (37,372 receiving SGLT2 inhibitors and 37,008 in the control group) were included. The analysed SGLT2 inhibitors included canagliflozin, dapagliflozin, empagliflozin, bexagliflozin, sotagliflozin, and ertugliflozin. The participants were non-advanced HF patients, including at-risk for HF, pre-HF, and symptomatic HF, with follow-up duration ranging from 12 to 296 weeks. Compared with the control, treatment with SGLT2 inhibitors was associated with significantly reduced risk of VAs (risk ratio (RR) 0.85, 95% confidence interval (CI) 0.74-0.98; P = 0.02) and SCD (RR 0.79, 95% CI 0.64-0.98; P = 0.03). Subgroup analyses indicated that longer follow-up (≥ 1 year) taking SGLT2 inhibitors can still reduce the risk of VAs (RR 0.79, 95% CI 0.65-0.96; P = 0.02) and SCD (RR 0.80, 95% CI 0.65-0.99; P = 0.04).
SGLT2 inhibitors have beneficial effects on lowering risks of VAs and SCD in patients with type 2 diabetes, cardiovascular diseases, heart failure with reduced ejection fraction (HFrEF), heart failure with preserved ejection fraction (HFpEF), and heart failure with mildly reduced ejection fraction (HFmrEF), with longer follow-up duration reinforcing these findings. However, future prospective trials are needed to verify the effects of SGLT2 inhibitors on VAs and SCD.
PROSPERO (CRD42024601914).
钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂已被证明可降低心力衰竭（HF）患者再次住院风险和心血管死亡率。然而，这些药物对室性心律失常（VAs）的影响尚未得到充分研究。为评估SGLT2抑制剂对不同HF阶段患者室性心律失常的有益影响，我们对涉及该患者群体使用SGLT2抑制剂的随机对照试验进行了系统评价和荟萃分析。
对截至2024年11月21日发表的临床试验，全面检索了PubMed、Embase、Ovid、ProQuest、Scopus和Cochrane数据库。感兴趣的主要结局是接受SGLT2抑制剂组与对照药物组之间室性心律失常和心源性猝死（SCD）的发生率。对于纳入试验人群及特定亚组中观察到的结局，汇总风险比（HRs）和95%置信区间（CIs）并进行荟萃分析。
共纳入23项随机试验（22项安慰剂对照试验和1项活性对照试验），涉及74380例患者（37372例接受SGLT2抑制剂，37008例在对照组）。分析的SGLT2抑制剂包括卡格列净、达格列净、恩格列净、贝西格列净、索格列净和依鲁格列净。参与者为非晚期HF患者，包括HF风险患者、HF前期患者和有症状HF患者，随访时间为12至296周。与对照组相比，使用SGLT2抑制剂治疗与室性心律失常风险显著降低相关（风险比（RR）0.85，95%置信区间（CI）0.74 - 0.98；P = 0.02）以及心源性猝死风险降低（RR 0.79，95% CI 0.64 - 0.98；P = 0.03）。亚组分析表明，服用SGLT2抑制剂更长时间的随访（≥1年）仍可降低室性心律失常风险（RR 0.79，95% CI 0.65 - 0.96；P = 0.02）和心源性猝死风险（RR 0.80，95% CI 0.65 - 0.99；P = 0.04）。
SGLT2抑制剂对降低2型糖尿病、心血管疾病、射血分数降低的心力衰竭（HFrEF）、射血分数保留的心力衰竭（HFpEF）以及射血分数轻度降低的心力衰竭（HFmrEF）患者的室性心律失常和心源性猝死风险具有有益作用，随访时间越长，这些结果越明显。然而，未来需要进行前瞻性试验以验证SGLT2抑制剂对室性心律失常和心源性猝死的影响。
PROSPERO（CRD42024601914）
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