Wannaphut Chalothorn, Wattanachayakul Phuuwadith, Saowapa Sakditad, Ponvilawan Ben, Tanariyakul Manasawee, Kewcharoen Jakrin, Yingchoncharoen Pitchaporn, Suenghataiphorn Thanathip, Aiumtrakul Noppawit, Acoba Jared
Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, USA.
Department of Medicine, Albert Einstein Healthcare Network, Philadelphia, PA, USA.
Ecancermedicalscience. 2025 Feb 11;19:1844. doi: 10.3332/ecancer.2025.1844. eCollection 2025.
BACKGROUND/OBJECTIVES: Sodium-glucose-co-transporter-2 (SGLT2) inhibitors have shown benefit in reducing cardiovascular disease outcomes in diabetes patients. Anthracycline therapy is associated with a risk of cardiomyopathy. However, the impact of SGLT2 inhibitors in the prevention of cardiomyopathy and heart failure in cancer patients undergoing anthracycline treatment remains unclear. Thus, we conducted a systematic review and meta-analysis to explore the effect of the prevention of cardiovascular outcomes in patients with cancer and diabetes who had received anthracycline therapy.
We systematically reviewed Medline and EMBASE databases from inception to January 2024 for studies focusing on cancer patients with a history of anthracycline therapy. Eligible studies had to report relative risk (RR) with 95% confidence intervals (CIs) for the clinical endpoints of mortality outcomes and the risk of heart failure exacerbation, comparing cohorts with and without SGLT2 inhibitor use.
Our study included four retrospective cohort studies in the meta-analysis ( = 6,708, 24% received SGLT2). There was significantly lower all-cause mortality in the SGLT2 inhibitors group (pooled RR of 0.52, 95% CI 0.35-0.77, 64%). However, there were no differences in the risk of heart failure exacerbation (pooled RR of 0.67, 95% CI 0.39-1.14, 17%).
Our study found that anthracycline-treated cancer patients using SGLT2 inhibitors experienced lower all-cause mortality compared to the control group. A randomised clinical trial is necessary to further elucidate these findings.
背景/目的：钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂已显示出对降低糖尿病患者心血管疾病结局有益。蒽环类药物治疗与心肌病风险相关。然而，SGLT2抑制剂在接受蒽环类药物治疗的癌症患者中预防心肌病和心力衰竭的影响仍不清楚。因此，我们进行了一项系统评价和荟萃分析，以探讨接受蒽环类药物治疗的癌症和糖尿病患者预防心血管结局的效果。
我们系统检索了从创刊至2024年1月的Medline和EMBASE数据库，以查找关注有蒽环类药物治疗史的癌症患者的研究。符合条件的研究必须报告死亡率结局和心力衰竭加重风险等临床终点的相对风险（RR）及95%置信区间（CI），比较使用和未使用SGLT2抑制剂的队列。
我们的研究在荟萃分析中纳入了四项回顾性队列研究（n = 6708，24%接受SGLT2抑制剂治疗）。SGLT2抑制剂组的全因死亡率显著更低（合并RR为0.52，95%CI为0.35 - 0.77，P = 0.001）。然而，心力衰竭加重风险无差异（合并RR为0.67，95%CI为0.39 - 1.14，P = 0.17）。
我们的研究发现，与对照组相比，使用SGLT2抑制剂的蒽环类药物治疗的癌症患者全因死亡率更低。有必要进行一项随机临床试验以进一步阐明这些发现。
