Objective Sodium-glucose cotransporter 2 inhibitors are widely used in the management of diabetes mellitus and have demonstrated substantial cardiovascular and renal protective effects, particularly in patients with heart failure. However, their impact on cardiovascular outcomes in patients with chronic obstructive pulmonary disease remains insufficiently characterized. Methods We conducted a systematic review and meta-analysis of randomized controlled trials to evaluate the efficacy and safety of sodium-glucose cotransporter 2 inhibitors in patients with chronic obstructive pulmonary disease. The primary outcome was the composite cardiovascular outcome (defined as cardiovascular mortality and total hospitalization for heart failure). Secondary outcomes included all-cause mortality, cardiovascular death, hospitalization for heart failure, and adverse events. Results Three randomized controlled trials involving 1986 patients with chronic obstructive pulmonary disease were included; in total, 1113 patients received sodium-glucose cotransporter 2 inhibitors treatment and 873 received placebo. Compared with the placebo, sodium-glucose cotransporter 2 inhibitors significantly reduced the risk of the composite cardiovascular outcome (risk ratio, 0.76; 95% confidence interval: 0.65–0.87; p < 0.001) and hospitalization for heart failure (risk ratio, 0.69; 95% confidence interval: 0.58–0.83; p < 0.001). Although not statistically significant, trends toward reduced all-cause mortality (risk ratio, 0.89; 95% confidence interval: 0.73–1.08; p = 0.23) and cardiovascular death (risk ratio, 0.96; 95% confidence interval: 0.74–1.24; p = 0.73) were observed. The incidence of adverse events was comparable between the two groups. Conclusions The use of sodium-glucose cotransporter 2 inhibitors is associated with a reduced risk of composite cardiovascular outcomes and hospitalization for heart failure in patients with chronic obstructive pulmonary disease, without an increased risk of adverse events. However, given the limited number of available trials, these findings should be interpreted with caution, and further large-scale studies are warranted. PROSPERO registration number: CRD42024545310
Lin et al. (Fri,) studied this question.
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