Cardiovascular Impacts of SGLT2 inhibitors on the Mitigation of Anthracycline Induced Cardiomyopathy: A Comprehensive Systematic Review and Meta-Analysis.

BackgroundAnthracycline-based chemotherapy is associated with cardiovascular toxicity, including cardiomyopathy, heart failure, and arrhythmias, for which established cardioprotective strategies remain limited.Given the established cardioprotective benefits of sodium-glucose cotransporter-2 inhibitors (SGLT2i), their association with cardiovascular outcomes in anthracycline-treated patients warrants systematic investigation. MethodsA systematic review and meta-analysis were performed according to PRISMA guidelines (PROSPERO ID: 1002398).PubMed, EMBASE, and Cochrane databases were searched through September 2024 for studies assessing SGLT2i use in anthracycline-treated patients.Outcomes included all-cause mortality, new-onset heart failure, heart failure hospitalization, and arrhythmia.Safety outcomes assessed included diabetic ketoacidosis (DKA), hypoglycemia, urinary tract infection (UTI), and sepsis.Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random-effects models, and study quality was assessed using the Newcastle-Ottawa Scale. ResultsFive studies (four observational, one case-control) including 14,244 patients (SGLT2i: 2,433; standard of care: 11,811) with a median follow-up of 1.83 years were analyzed.SGLT2i use was associated with lower odds of all-cause mortality (OR 0.49, 95% CI 0.30-0.80),newonset heart failure (OR 0.26, 95% CI 0.09-0.77),heart failure hospitalization (OR 0.28, 95% CI 0.17-0.47),and arrhythmia (OR 0.36, 95% CI 0.21-0.63).Heterogeneity varied across outcomes.Safety outcomes were comparable, with fewer reported UTI events in the SGLT2i group. ConclusionsSGLT2i use was associated with lower odds of all-cause mortality, arrhythmia, and heart failurerelated outcomes in anthracycline-treated patients.These findings are hypothesis-generating and warrant prospective validation.