Huang Wenxi, Tang Huilin, Li Yujia, Chen Wei-Han, Chang Shao-Hsuan, Bian Jiang, Ahmed Mustafa M, Kimmel Stephen E, Guo Jingchuan
Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, 1889 Museum Road, DSIT 6004, Gainesville, FL, 32606, USA.
Biostatistics and Health Data Science, School of Medicine, Indiana University, Indianapolis, IN, USA.
Am J Cardiovasc Drugs. 2025 Jul 11. doi: 10.1007/s40256-025-00745-w.
Heart failure (HF) poses a significant public health burden in the USA and worldwide, with a higher incidence and disproportionate presentation at a younger age in Asian populations than in other racial and ethnic groups.
This study aimed to evaluate the treatment efficacy of different HF pharmacological interventions in Asian versus white patients with HF with reduced ejection fraction (HFrEF).
We conducted a pairwise meta-analysis of randomized controlled trials (RCTs) in adults with HFrEF. We searched the Embase, PubMed, and Cochrane Central Register of Controlled Trials databases from inception to February 9, 2022. We identified RCTs investigating the efficacy of HF drugs, including angiotensin-converting enzyme inhibitors, an angiotensin receptor-neprilysin inhibitor (sacubitril/valsartan), beta-blockers, hyperpolarization-activated cyclic nucleotide-gated channel blockers, sodium-glucose cotransporter 2 (SGLT2) inhibitors, renin inhibitors, vasopressin V2 receptor blockers, and oral soluble guanylate cyclase stimulators. The primary outcome was a composite endpoint of hospitalization of HF, cardiovascular death, and all-cause mortality.
We included 11 RCTs involving 32,654 participants from Asian and white populations. In Asian patients, SGLT2 inhibitors (risk ratio [RR] 0.61; 95% confidence interval [CI] 0.49-0.75) were the most effective in reducing the composite endpoint of hospitalization of HF, followed by hyperpolarization-activated cyclic nucleotide-gated channel blockers (RR 0.62; 95% CI 0.42-0.89). In white patients, beta-blockers (RR 0.68; 95% CI 0.59-0.78) were the most effective in lowering the risk of adverse outcomes, followed by SGLT2 inhibitors (RR 0.72; 95% CI 0.53-0.97). Overall, SGLT2 inhibitors were the most effective treatment in reducing the risk of adverse outcomes among all patients with HFrEF (RR 0.72; 95% CI 0.53-0.97), with a better treatment effect in Asian patients than in their white counterparts (P_interaction = 0.014).
The findings from this study suggest that treatment with SGLT2 inhibitors is effective in lowering the risk of adverse clinical outcomes in patients with HFrEF for both Asian and white populations, with a more pronounced effect in Asian populations. These results highlight the importance of considering racial and ethnic differences in the management of HF.
心力衰竭（HF）在美国及全球范围内都构成了重大的公共卫生负担，与其他种族和族裔群体相比，亚洲人群中HF的发病率更高，且在较年轻年龄段的发病率不成比例。
本研究旨在评估不同HF药物干预措施对亚洲与白人射血分数降低的心力衰竭（HFrEF）患者的治疗效果。
我们对成人HFrEF随机对照试验（RCT）进行了配对荟萃分析。我们检索了Embase、PubMed和Cochrane对照试验中央注册库数据库，检索时间从数据库建立至2022年2月9日。我们确定了研究HF药物疗效的RCT，这些药物包括血管紧张素转换酶抑制剂、血管紧张素受体脑啡肽酶抑制剂（沙库巴曲/缬沙坦）、β受体阻滞剂、超极化激活环核苷酸门控通道阻滞剂、钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂、肾素抑制剂、血管加压素V2受体阻滞剂和口服可溶性鸟苷酸环化酶刺激剂。主要结局是HF住院、心血管死亡和全因死亡的复合终点。
我们纳入了11项RCT，涉及来自亚洲和白人人群的32654名参与者。在亚洲患者中，SGLT2抑制剂（风险比[RR]0.61；95%置信区间[CI]0.49-0.75）在降低HF住院复合终点方面最有效，其次是超极化激活环核苷酸门控通道阻滞剂（RR 0.62；95%CI 0.42-0.89）。在白人患者中，β受体阻滞剂（RR 0.68；95%CI 0.59-0.78）在降低不良结局风险方面最有效，其次是SGLT2抑制剂（RR 0.72；95%CI 0.53-0.97）。总体而言，SGLT2抑制剂是降低所有HFrEF患者不良结局风险最有效的治疗方法（RR 0.72；95%CI 0.53-0.97），在亚洲患者中的治疗效果优于白人患者（交互P值=0.014）。
本研究结果表明，SGLT2抑制剂治疗可有效降低亚洲和白人HFrEF患者不良临床结局的风险，在亚洲人群中的效果更显著。这些结果凸显了在HF管理中考虑种族和族裔差异的重要性。
