Li Yujia, Tang Huilin, Huang Wenxi, Chen Wei-Han, Chang Shao-Hsuan, Bian Jiang, Ahmed Mustafa M, Kimmel Stephen E, Guo Jingchuan
Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, FL, United States.
Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL, United States.
Front Cardiovasc Med. 2025 Jun 30;12:1482311. doi: 10.3389/fcvm.2025.1482311. eCollection 2025.
To evaluate the effect of different pharmacological therapies for heart failure (HF) between the Black vs. White population.
We included randomized controlled trials (RCT) of HF pharmacological therapies with explicit strata of Black or White adults in the primary or secondary analysis. We examined three outcomes: (1) the composite of CV death or hospitalization for heart failure (HHF), (2) HHF, and (3) all-cause death. Within each race (White and Black), we calculated the pooled risk ratio (RR) with a 95% confidence interval (CI) of different pharmacological therapies using random-effects models. Within each pharmacological therapies, we assess the differences in the treatment effect by race.
In 19 RCT reporting eight pharmacological therapies, there was no significant difference between the Black and White groups for using sacubitril/valsartan, angiotensin-converting enzyme inhibitors, calcium-channel blockers, direct renin inhibitors, oral soluble guanylate cyclase, or vasodilators. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) had a different effect in HHF across the White and Black patients (P = .030), with a better treatment effect observed in the Black (RR 0.39, 95% CI 0.19-0.80) compared to the White group (0.90, 0.71-1.14). Beta-blockers had a better treatment effect in the White (0.65, 0.52-0.81) compared to the Black group (1.14, 0.88-1.47) regarding the all-cause death outcome (P = .001).
Black individuals with HF appeared to obtain a greater benefit of HHF risk reduction from SGLT2i and less benefit for mortality from beta-blockers compared to their White counterparts.
评估黑种人与白种人群中不同药物治疗对心力衰竭（HF）的效果。
我们纳入了在主要或次要分析中明确划分黑种或白种成年人群的HF药物治疗随机对照试验（RCT）。我们考察了三个结局：（1）心血管死亡或因心力衰竭住院（HHF）的复合结局，（2）HHF，以及（3）全因死亡。在每个种族（白种人和黑种人）内部，我们使用随机效应模型计算不同药物治疗的合并风险比（RR）及95%置信区间（CI）。在每种药物治疗内部，我们评估种族间治疗效果的差异。
在报告了八种药物治疗的19项RCT中，使用沙库巴曲缬沙坦、血管紧张素转换酶抑制剂、钙通道阻滞剂、直接肾素抑制剂、口服可溶性鸟苷酸环化酶或血管扩张剂时，黑种人和白种人群之间无显著差异。钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）在白种和黑种患者的HHF方面有不同效果（P = 0.030），与白种人群（0.90，0.71 - 1.14）相比，黑种人群的治疗效果更好（RR 0.39，95% CI 0.19 - 0.80）。关于全因死亡结局，与黑种人群（1.14，0.88 - 1.47）相比，β受体阻滞剂在白种人群中的治疗效果更好（0.65，0.52 - 0.81）（P = 0.001）。
与白种人相比，患有HF的黑种人似乎从SGLT2i中获得更大的降低HHF风险的益处，而从β受体阻滞剂中获得的降低死亡率的益处较少。
