Sodium-glucose cotransporter 2 inhibitors significantly reduced the relative risk of hospitalization for heart failure by 27-39% versus placebo, regardless of type-2 diabetes mellitus status.
Systematic Review
Do SGLT2 inhibitors reduce hospitalization for heart failure and improve cardiac structure/function in patients with or without type-2 diabetes mellitus?
SGLT2 inhibitors reduce heart failure hospitalizations regardless of T2DM status, potentially driven by reversal of adverse left ventricular remodeling.
Effect estimate: Relative risk reduction 27-39%
AIMS: To systematically review randomized controlled trials assessing effects of sodium-glucose cotransporter 2 inhibitors (SGLT2is) on hospitalization for heart failure (HHF) and cardiac structure/function and explore randomized controlled trial (RCT)-derived evidence for SGLT2i efficacy mechanisms in heart failure (HF). METHODS AND RESULTS: Systematic searches of Medline and Embase were performed. In seven trials 3730-17 160 patients; low risk of bias (RoB), SGLT2is significantly reduced the relative risk of HHF by 27-39% vs. placebo, including in two studies in patients with HF with reduced ejection fraction with or without type-2 diabetes mellitus (T2DM). Improvements in conventional cardiovascular risk factors, including glycaemic levels, cannot account for these effects. Five trials (56-105 patients; low RoB) assessed the effects of 6-12 months of SGLT2i treatment on left ventricular structure/function; four reported significant improvements vs. placebo, and one did not. Five trials (low RoB) assessed SGLT2i treatment effects on serum N-terminal pro B-type natriuretic peptide levels; significant reductions vs. placebo were reported after 8-12 months (two studies; 3730-4744 patients) but not ≤12 weeks (three studies; 80-263 patients). Limited available RCT-derived evidence suggests various possible cardioprotective SGLT2i mechanisms, including improved haemodynamics (natriuresis and reduced interstitial fluid without blood volume contraction/neurohormonal activation) and vascular function, enhanced erythropoiesis, reduced tissue sodium and epicardial fat/inflammation, decreased sympathetic tone, and beneficial changes in cellular energetics. CONCLUSIONS: Sodium-glucose cotransporter 2 inhibitors reduce HHF regardless of T2DM status, and reversal of adverse left ventricular remodelling likely contributes to this efficacy. Hypothesis-driven mechanistic trials remain sparse, although numerous trials are planned or ongoing.
Rasalam et al. (Mon,) conducted a systematic review in Heart failure. Sodium-glucose cotransporter 2 inhibitors (SGLT2is) vs. placebo was evaluated on Hospitalization for heart failure (HHF) (Relative risk reduction 27-39%). Sodium-glucose cotransporter 2 inhibitors significantly reduced the relative risk of hospitalization for heart failure by 27-39% versus placebo, regardless of type-2 diabetes mellitus status.