Abstract
Sodium-glucose cotransporter-2 (SGLT2) inhibitors represent newly developed oral antidiabetic drugs that are practiced for type 2 diabetes mellitus management and may decrease the risk of the first hospitalization in heart failure. The activity of SGLT2 inhibitors is not related to glucose, and the effectiveness and safety of SGLT2 inhibitors in individuals with chronic heart failure (CHF) remain unclear. We systematically retrieved PubMed, Cochrane Library, Embase, NCKI, VIP, Wanfang Data, and ClinicalTrials.gov records to identify eligible trials. The primary endpoints were cardiovascular death/hospitalization for heart failure (CV death/HHF), cardiovascular death, and hospitalization for heart failure. Secondary endpoints included hypoglycemia, volume depletion, urinary tract infection, left ventricular ejection fraction (LVEF), and NT-proBNP. Nine randomized controlled clinical trials were included. Dapagliflozin was reported to significantly decrease CV death/HHF (relative risk (RR): 0.75; 95% confidence interval (CI): 0.68–0.84), CV death (RR: 0.80; 95% CI: 0.68–0.93), and HHF (RR: 0.72; 95% CI: 0.63–0.83). There was no effect on hypoglycemia (RR: 0.69; 95% CI: 0.34–1.40), volume depletion (RR: 1.17; 95% CI: 0.97–1.41), urinary tract infection (RR: 0.82; 95% CI: 0.43–1.57), LVEF (WMD: 0.53; 95% CI: −4.04–5.09), or NT-proBNP (SMD: −0.66; 95% CI: −1.42–0.10). The risk of CV death/HHF, CV death, and HHF was lower among patients receiving dapagliflozin than patients receiving placebo.
Highlights
According to ESC guidelines, HF is a clinical syndrome characterized by typical symptoms that may be accompanied by signs caused by a structural and/ or functional cardiac abnormality, resulting in a reduced cardiac output and/or elevated intracardiac pressures at rest or during stress [1]
Results of the recently conducted clinical studies have shown that sodium-glucose cotransporter-2 (SGLT2) inhibitors can reduce the risk of chronic heart failure (CHF) in individuals having type 2 diabetes mellitus (T2DM) [4,5,6,7,8,9]
Using a model of random effects, we demonstrated that dapagliflozin highly decreased the prevalence of CV death/HHF (RR: 0.75, 95% confidence interval (CI): 0.68–0.84, and p < 0.00001) (Figure 3(a))
Summary
According to ESC guidelines, HF is a clinical syndrome characterized by typical symptoms (e.g., breathlessness, ankle swelling, and fatigue) that may be accompanied by signs (e.g., elevated jugular venous pressure, pulmonary crackles, and peripheral oedema) caused by a structural and/ or functional cardiac abnormality, resulting in a reduced cardiac output and/or elevated intracardiac pressures at rest or during stress [1]. Due to the use of aldosterone receptor antagonists, angiotensin-converting enzyme inhibitors (ACEIs), β-blockers, and angiotensin receptor blockers (ARBs), CHF evolved from a fatal disease to a severe disease that needs long-term team management [3]. Results of the recently conducted clinical studies have shown that sodium-glucose cotransporter-2 (SGLT2) inhibitors can reduce the risk of CHF in individuals having type 2 diabetes mellitus (T2DM) [4,5,6,7,8,9]. Recent clinical trials have shown that the SGLT2 inhibitor dapagliflozin can reduce the cardiovascular death/hospitalization for heart failure (CV death/HHF) in patients with CHF, whether or not they have T2DM [10,11,12].
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