SGLT2i reduces risk of cardiovascular death, heart failure symptoms, hospitalization

Treatment with sodium-glucose cotransporter-2 inhibitors (SGLT2i) results in a lower risk of clinically relevant cardiovascular death, heart failure (HF) hospitalization, and HF symptoms with similar rates of adverse events (AEs), results of a meta-analysis have shown.

Use of SGLT2i, compared with placebo, correlated with a substantial reduction in cardiovascular death or HF hospitalization (hazard ratio [HR], 0.74, 95 percent confidence interval [CI], 0.66–0.82; p<0.01), HF hospitalization (HR, 0.69, 95 percent CI, 0.57–0.84; p<0.01), cardiovascular death (HR, 0.79, 95 percent CI, 0.68–0.92; p<0.01), and any death (HR, 0.80, 95 percent CI, 0.70–0.92; p<0.01).

The investigators completed this meta-analysis according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, with the aim of further clarifying the role of SGLT2i in patients with pre-existing HF with reduced ejection fraction with or without diabetes and to leverage increased sample size and power to evaluate clinically important secondary safety and efficacy outcomes.

Cardiovascular death or HF hospitalization was the primary outcome, while secondary ones included the individual components of the primary outcome: major adverse cardiovascular events (defined as a composite of cardiovascular death, myocardial infarction [MI], and stroke), any death, MI, or stroke, along with AEs such as volume depletion, acute kidney injury, AEs leading to drug discontinuation, amputation, and severe hypoglycaemia. Other outcomes were the Kansas City Cardiomyopathy Questionnaire total symptom score and changes in N-terminal prohormone BNP.