Key result
Post-aortic valve intervention SGLT2 inhibitors are linked to ~31% lower all-cause mortality.
Why the study?
Residual mortality and heart failure events remain common after aortic valve intervention for severe aortic stenosis, but the role of SGLT2 inhibitors following transcatheter or surgical intervention remains uncertain.
Does SGLT2 inhibitor therapy reduce mortality and heart failure events in adults following aortic valve intervention for severe aortic stenosis?
Meta-Analysis
Does SGLT2 inhibitor therapy reduce mortality and heart failure events in adults following aortic valve intervention for severe aortic stenosis?
Hazard Ratio: 0.69 (95% CI 0.6–0.79)
p-value: p=<0.001
SGLT2 inhibitor therapy after aortic valve intervention is associated with significantly lower all-cause mortality, though the evidence is predominantly observational and requires confirmation in dedicated randomized trials.
May support SGLT2 inhibitor use after aortic valve intervention; leaves open confirmation in dedicated randomized trials.
Background Residual mortality and heart-failure events remain common after aortic valve intervention for severe aortic stenosis. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) improve cardiovascular and renal outcomes in heart-failure, diabetes, and chronic kidney disease populations, but their role following transcatheter or surgical aortic valve intervention remains uncertain. Methods PubMed, Scopus, ScienceDirect, Cochrane Library, citation tracking, and manually identified eligible studies were screened through June 2026 for randomized and observational studies comparing SGLT2i with usual care or no SGLT2i after aortic valve intervention. The review was registered in PROSPERO (CRD420251059332). Eligible populations included TAVR, SAVR, and bioprosthetic aortic valve evidence where available. Adjusted hazard ratios (HRs) were pooled using random-effects models while non-HR estimates and non-comparable endpoints were summarized narratively. Results Twelve eligible reports were included, comprising one randomized trial and 11 observational studies. Most time-to-event estimates were reported from TAVR cohorts; two SAVR-only studies and one mixed bioprosthetic AVR study added complementary surgical and valve-durability data. In the pooled time-to-event analysis, SGLT2i use was associated with lower all-cause mortality (HR 0.69, 95% CI 0.60–0.79; I²=5%; p < 0.001). The study-defined composite clinical outcome was also lower (HR 0.68, 95% CI 0.53–0.89; I²=57%; p = 0.005), although component definitions differed across studies. Estimates for heart-failure hospitalization or exacerbation, atrial fibrillation, and acute kidney injury were not statistically significant. Conclusions SGLT2i use after aortic valve intervention was associated with lower all-cause mortality in pooled time-to-event analysis. SAVR data were clinically informative but were not sufficiently homogeneous for separate quantitative pooling. Findings for composite, heart-failure, rhythm, renal, and valve-related outcomes remain less certain. Dedicated randomized trials are needed to confirm whether the observed association reflects a treatment effect and to define patient selection, treatment timing, and peri-procedural safety.
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Megantara et al. (2026) conducted a meta-analysis in Aortic stenosis undergoing aortic valve intervention. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) vs. Usual care, placebo, no SGLT2i, or active non-SGLT2i therapy was evaluated on All-cause mortality (HR 0.69, 95% CI 0.60-0.79, p=<0.001). SGLT2 inhibitor use after aortic valve intervention was associated with a 31% lower risk of all-cause mortality compared to usual care or no SGLT2 inhibitor (HR 0.69).
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