Key result
SGLT2 inhibitors reduce heart failure hospitalizations ~32% vs. placebo, with consistent benefit regardless of diabetes.
Why the study?
Few studies have investigated the role of SGLT2 inhibitors in patients with heart failure with and without diabetes.
Do SGLT2 inhibitors reduce hospitalization for heart failure and mortality in patients with heart failure with and without diabetes?
Meta-Analysis (n=75,287)
Do SGLT2 inhibitors reduce hospitalization for heart failure and mortality in patients with heart failure with and without diabetes?
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“If you looked to almost all [randomized controlled trials] evaluating safety and efficacy of SGLT2 inhibitors—either in those early cardiovascular safety trials in patients with diabetes mellitus but without heart failure or in RCTs of heart failure patients with or without diabetes mellitus—you will find an astonishingly consistent signal for reduction of incident heart failure hospitalization with similar relative risk reduction in the range of 27% in some trials, to 35% in others.”
“it confirms the efficacy and safety of SGLT2 inhibitors in patients with heart failure, both with and without diabetes.”
SGLT2 inhibitors significantly reduce the risk of hospitalization for heart failure regardless of underlying diabetes status, establishing their role as foundational guideline-directed medical therapy.
Heart failure (HF) is the most common cardiovascular cause of hospitalization in patients over 60 years, affecting about 64.3 million patients worldwide. Few studies have investigated the role of sodium glucose cotransporter inhibitors (SGLT2Is) in patients with HF without and without diabetes. Thus, we conducted our meta-analysis to further investigate the role of SGLT2I role in patients with HF without and without diabetes. PubMed, Scopus, Web of Science, and Embase were searched. All clinical trials that compared the effect of SGLT2Is versus placebo on patients with HF were included. Dichotomous data were extracted, pooled as risk ratio (RR) with 95% confidence interval (CI), and analyzed using RevMan version 5.3 for windows using the Mantel-Haenszel method. A total of 13 randomized clinical trials were included for analysis, with a total number of 75,287 patients. SGLT2Is significantly lowered the risk of hospitalization for HF in patients with (RR = 0.68, 95% CI 0.63 to 0.74) and without diabetes (RR = 0.75, 95% CI 0.62 to 0.89). Furthermore, they lowered the mortality risk in both patients with diabetes with statistical significance (RR = 0.87, 95% CI 0.77 to 0.99), yet without statistical significance in patients without diabetes (RR = 0.93, 95% CI 0.70 to 1.23). Further analyses for serious adverse events were conducted, and SGLT2I showed a significant lower risk in patients with diabetes (RR = 0.94, 95% CI 0.90 to 0.98) and without diabetes (RR = 0.72, 95% CI 0.38 to 1.39). in patients with diabetes, SGLT2Is significantly reduced cardiovascular mortality, HHF, and serious adverse events. However, in patients without, despite showing a significant reduction in HHF, SGLT2I reduced cardiovascular mortality or serious adverse events but without statistical significance.
Journal, society, and media accounts. Useful signal, not independent expert judgment.
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Hasan et al. (2022) conducted a meta-analysis in Heart failure (with and without diabetes) (n=75,287). SGLT2 inhibitors vs. Placebo was evaluated on Hospitalization for heart failure in patients with diabetes (RR 0.68, 95% CI 0.63 to 0.74). SGLT2 inhibitors significantly lowered the risk of hospitalization for heart failure in patients with diabetes (RR 0.68) and without diabetes (RR 0.75) compared to placebo.
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