Hatamura Miyu, Tsuji Shuhei, Tazaki Junichi, Toyofuku Mamoru
Department of Cardiovascular Medicine, Japanese Red Cross Wakayama Medical Center Wakayama Japan.
Circ Rep. 2025 Mar 7;7(5):323-330. doi: 10.1253/circrep.CR-25-0008. eCollection 2025 May 9.
Previous reports have shown that sodium-glucose cotransporter 2 inhibitors (SGLT2i) benefit patients with heart failure (HF), regardless of left ventricular ejection fraction. However, evidence is limited for patients who are underweight, particularly with a body mass index (BMI) <20 kg/m.
Between February 2022 and July 2023, 533 patients were hospitalized at the Japanese Red Cross Wakayama Medical Center for acute HF. Excluding those who died during hospitalization, we categorized 488 patients according to their BMI at discharge: <20 kg/m (n=201), and ≥20 kg/m (n=287). Among the BMI <20 kg/m group, SGLT2i was prescribed to 53 patients. The cumulative incidence rates of all-cause mortality at 1 year were significantly different between BMI <20 kg/m patients with and without SGLT2i (11.8% vs. 36.1%; log-rank P=0.004). In the multivariate Cox proportional hazard models, SGLT2i reduced the risk of all-cause mortality independent of age, frailty, walking speed, decreased albumin level, elevated C-reactive protein level, and prescriptions of renin-angiotensin-aldosterone system inhibitors and mineralocorticoid receptor antagonists. However, among patients who received SGLT2i, the SGLT2i prescription continuation rate at 1 year was not significantly different between the BMI <20 kg/m and BMI ≥20 kg/m groups (85.4% vs. 84.6%; log-rank P=0.869).
SGLT2i are feasibly effective and well-tolerated drugs, even for patients with low BMI.
既往报告显示，钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）对心力衰竭（HF）患者有益，无论其左心室射血分数如何。然而，体重过轻的患者，尤其是体重指数（BMI）<20kg/m²的患者，相关证据有限。
2022年2月至2023年7月期间，533例患者因急性HF入住日本红十字会和歌山医疗中心。排除住院期间死亡的患者后，我们根据出院时的BMI将488例患者分为：<20kg/m²（n=201）和≥20kg/m²（n=287）。在BMI<20kg/m²组中，53例患者使用了SGLT2i。BMI<20kg/m²且使用和未使用SGLT2i的患者1年全因死亡率的累积发生率有显著差异（11.8%对36.1%；对数秩检验P=0.004）。在多变量Cox比例风险模型中，SGLT2i可降低全因死亡风险，且独立于年龄、虚弱程度、步行速度、白蛋白水平降低、C反应蛋白水平升高以及肾素-血管紧张素-醛固酮系统抑制剂和盐皮质激素受体拮抗剂的使用情况。然而，在使用SGLT2i的患者中，BMI<20kg/m²组和BMI≥20kg/m²组1年时SGLT2i处方持续率无显著差异（85.4%对84.6%；对数秩检验P=0.869）。
SGLT2i是可行有效的且耐受性良好的药物，即使对于低BMI患者也是如此。
