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Sodium-glucose cotransporter 2 inhibitor effects on heart failure hospitalization and cardiac function: systematic review.

Authors
  • Rasalam, Roy1
  • Atherton, John J2
  • Deed, Gary3
  • Molloy-Bland, Michael4
  • Cohen, Neale5
  • Sindone, Andrew6
  • 1 College of Medicine & Dentistry, James Cook University, Townsville, QLD, Australia. , (Australia)
  • 2 Royal Brisbane and Women's Hospital, Faculty of Medicine, University of Queensland, Herston, QLD, Australia. , (Australia)
  • 3 Mediwell Medical Clinic, Coorparoo, QLD, Australia. , (Australia)
  • 4 Oxford PharmaGenesis, Melbourne, VIC, Australia. , (Australia)
  • 5 Baker Heart and Diabetes Institute, Melbourne, VIC, Australia. , (Australia)
  • 6 Concord Hospital, University of Sydney, Concord, NSW, Australia. , (Australia)
Type
Published Article
Journal
ESC heart failure
Publication Date
Oct 01, 2021
Volume
8
Issue
5
Pages
4093–4118
Identifiers
DOI: 10.1002/ehf2.13483
PMID: 34219407
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

To systematically review randomized controlled trials assessing effects of sodium-glucose cotransporter 2 inhibitors (SGLT2is) on hospitalization for heart failure (HHF) and cardiac structure/function and explore randomized controlled trial (RCT)-derived evidence for SGLT2i efficacy mechanisms in heart failure (HF). Systematic searches of Medline and Embase were performed. In seven trials [3730-17 160 patients; low risk of bias (RoB)], SGLT2is significantly reduced the relative risk of HHF by 27-39% vs. placebo, including in two studies in patients with HF with reduced ejection fraction with or without type-2 diabetes mellitus (T2DM). Improvements in conventional cardiovascular risk factors, including glycaemic levels, cannot account for these effects. Five trials (56-105 patients; low RoB) assessed the effects of 6-12 months of SGLT2i treatment on left ventricular structure/function; four reported significant improvements vs. placebo, and one did not. Five trials (low RoB) assessed SGLT2i treatment effects on serum N-terminal pro B-type natriuretic peptide levels; significant reductions vs. placebo were reported after 8-12 months (two studies; 3730-4744 patients) but not ≤12 weeks (three studies; 80-263 patients). Limited available RCT-derived evidence suggests various possible cardioprotective SGLT2i mechanisms, including improved haemodynamics (natriuresis and reduced interstitial fluid without blood volume contraction/neurohormonal activation) and vascular function, enhanced erythropoiesis, reduced tissue sodium and epicardial fat/inflammation, decreased sympathetic tone, and beneficial changes in cellular energetics. Sodium-glucose cotransporter 2 inhibitors reduce HHF regardless of T2DM status, and reversal of adverse left ventricular remodelling likely contributes to this efficacy. Hypothesis-driven mechanistic trials remain sparse, although numerous trials are planned or ongoing. © 2021 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.

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