Key result
SGLT2 inhibitors reduce HHF or CV mortality by ~22% vs control in HFpEF.
Why the study?
Although SGLT2 inhibitors reduce mortality and hospitalization in HFrEF, their effect in patients with HFpEF has not been well studied.
Do SGLT2 inhibitors reduce the composite of first hospitalization for heart failure or cardiovascular mortality in patients with heart failure with preserved ejection fraction?
Meta-Analysis (n=10,883)
Do SGLT2 inhibitors reduce the composite of first hospitalization for heart failure or cardiovascular mortality in patients with heart failure with preserved ejection fraction?
SGLT2 inhibitors significantly improve cardiovascular outcomes with a lower risk of serious adverse events in patients with HFpEF, though more trials are needed.
Supports SGLT2 inhibitor use in HFpEF to reduce HF hospitalization or CV death; extends prior evidence but low-certainty data require further RCTs.
Background: Heart failure with preserved ejection fraction (HFpEF) is associated with a high risk of mortality and frequent hospitalization. Sodium-glucose cotransporter 2 (SGLT2) inhibitors have favorable cardiovascular protective effect and could decrease the risk of mortality and hospitalization in patients with heart failure with reduced ejection fraction. However, the effect of SGLT2 inhibitors for HFpEF has not been well studied. Purpose: The aim of this meta-analysis is to systematically assess the effects of SGLT2 inhibitors in patients with HFpEF. Methods: MEDLINE, EMBASE, Ovid, Cochrane Library, Chinese National Knowledge Infrastructure Database, VIP database, Chinese Biomedical Database, and Wanfang Database were searched from inception to November 2021 for randomized controlled trials (RCTs) of SGLT2 inhibitors for HFpEF. Risk bias was assessed for included studies according to Cochrane handbook. The primary outcome was the composite of first hospitalization for heart failure (HHF) or cardiovascular mortality. First HHF, cardiovascular mortality, total HHF, all-cause mortality, exercise capacity, ventricular diastolic function, and adverse events were considered as secondary endpoints. PROSPERO registration: CRD42021291122. No statistical differences were found in terms of cardiovascular mortality, all-cause mortality, NT-proBNP, BNP and 6-min walk test distance. Conclusion: SGLT2 inhibitors significantly improve cardiovascular outcomes with a lower risk of serious adverse events in patients with HFpEF. However, these findings require careful recommendation due to the small number of RCTs at present. More multi-center, randomized, double-blind, placebo-controlled trials are needed. Systematic Review Registration: [https://www.crd.york.ac.Uk/prospero/], identifier [CRD42021291122].
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Zhou et al. (2022) conducted a meta-analysis in Heart failure with preserved ejection fraction (HFpEF) (n=10,883). Sodium-glucose cotransporter 2 (SGLT2) inhibitors vs. Placebo, no drug, or antidiabetics was evaluated on Composite of first hospitalization for heart failure (HHF) or cardiovascular mortality (HR 0.78, 95% CI 0.70-0.87, p=<0.00001). SGLT2 inhibitors significantly reduced the composite of first hospitalization for heart failure or cardiovascular mortality (HR 0.78) compared to control in patients with HFpEF.
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