Abstract 11422: The Effect of Sodium-Glucose Cotransporter-2 Inhibitors on Stroke in Patients With Heart Failure With Preserved Ejection Fraction: A Meta-Analysis of Randomized Controlled Trials

Abstract

Background: Randomized controlled trials on sodium-glucose cotransporter-2 (SGLT2) inhibitors in patients with heart failure with reduced ejection fraction (HFrEF) have shown them to be beneficial in improving cardiovascular outcomes, including improvement in heart failure parameters and reduced risk of major adverse cardiovascular events (MACE). Positive results are also noted in patients with heart failure with preserved ejection fraction (HFpEF). However, it is unclear if they have any additional benefit of decreased risk of stroke in this patient population of HFpEF. Methods: We performed MEDLINE (via PubMed) and ClinicalTrials.gov searches using the search words - SGLT2 inhibitors and heart failure. Among the reports identified, we screened for randomized controlled trials on HFpEF, that had stroke as one of their outcomes or side effects. We identified three studies that can be included in our meta-analysis. Results: 12,553 (6279 in the treatment group and 6274 in the placebo group) are included in the meta-analysis. The baseline characteristics in both groups were similar. Among the patients treated for HFpEF, the total number of patients who had an ischemic stroke in the SGLT2 inhibitor group was 113 out of 6279 (1.8%), while in the placebo group, 101 out of 6274 (1.6%). We found that SGLT2 inhibitors did not significantly decrease the risk of ischemic stroke in patients treated for heart failure with preserved EF with a relative risk of 1.12 and 95% CI of 0.86 to 1.46. Conclusion: Our meta-analysis shows that in patients treated for HFpEF, SGLT2 inhibitors have a neutral effect on the risk of ischemic stroke.