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Sodium-Glucose Cotransporter-2 Inhibitors in Patients With Heart Failure : A Systematic Review and Meta-analysis.
Zou, Xinyu; Shi, Qingyang; Vandvik, Per Olav; Guyatt, Gordon; Lang, Chim C; Parpia, Sameer; Wang, Si; Agarwal, Arnav; Zhou, Yiling; Zhu, Ye; Tian, Haoming; Zhu, Zhiming; Li, Sheyu.
Afiliação
  • Zou X; Department of Endocrinology and Metabolism, Division of Guideline and Rapid Recommendation, Cochrane China Center, MAGIC China Center, Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China (X.Z., Q.S., Y.Zhou, H.T.).
  • Shi Q; Department of Endocrinology and Metabolism, Division of Guideline and Rapid Recommendation, Cochrane China Center, MAGIC China Center, Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China (X.Z., Q.S., Y.Zhou, H.T.).
  • Vandvik PO; Department of Medicine, Lovisenberg Diaconal Hospital, Oslo, Norway (P.O.V.).
  • Guyatt G; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada (G.G., S.P.).
  • Lang CC; Division of Molecular and Clinical Medicine, Ninewells Hospital, University of Dundee, Dundee, United Kingdom (C.C.L.).
  • Parpia S; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada (G.G., S.P.).
  • Wang S; Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China (S.W., Y.Zhu).
  • Agarwal A; Department of Medicine, McMaster University, Hamilton, Ontario, Canada (A.A.).
  • Zhou Y; Department of Endocrinology and Metabolism, Division of Guideline and Rapid Recommendation, Cochrane China Center, MAGIC China Center, Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China (X.Z., Q.S., Y.Zhou, H.T.).
  • Zhu Y; Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China (S.W., Y.Zhu).
  • Tian H; Department of Endocrinology and Metabolism, Division of Guideline and Rapid Recommendation, Cochrane China Center, MAGIC China Center, Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China (X.Z., Q.S., Y.Zhou, H.T.).
  • Zhu Z; Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University, Chongqing, China (Z.Z.).
  • Li S; Department of Endocrinology and Metabolism, Division of Guideline and Rapid Recommendation, Cochrane China Center, MAGIC China Center, Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China, and Division of Population Health and Genomics, Ninewells Hospital,
Ann Intern Med ; 175(6): 851-861, 2022 06.
Article em En | MEDLINE | ID: mdl-35404670
ABSTRACT

BACKGROUND:

Randomized controlled trials established the cardiac protection of sodium-glucose cotransporter-2 (SGLT2) inhibitors among adults with type 2 diabetes. New evidence suggests that these results could extend to people without diabetes.

PURPOSE:

To evaluate the effect of SGLT2 inhibitors in patients with heart failure, regardless of the presence of type 2 diabetes. DATA SOURCES PubMed, Web of Science, Cochrane Library, and Embase (OVID interface). STUDY SELECTION Eligible trials randomly assigned adults with heart failure to SGLT2 inhibitors or control. DATA EXTRACTION Time-to-event individual patient data were reconstructed from published Kaplan-Meier plots; time-varying risk ratios (RRs) were calculated in half-, 1-, and 2-year time frames; and anticipated absolute benefits were calculated using simple models applying relative effects to baseline risks. DATA

SYNTHESIS:

Sodium-glucose cotransporter-2 inhibitors reduce hospitalization for heart failure by 37% (95% CI, 25% to 47%) at 6 months, 32% (CI, 20% to 42%) at 1 year, and 26% (CI, 10% to 40%) at 2 years (all high certainty) and reduce cardiovascular death by 14% (CI, 1% to 25%) at 1 year (high certainty). Nevertheless, low-certainty evidence did not indicate protection against all-cause death, kidney disease progression, or kidney failure. Anticipated absolute benefits are greater for patients treated in the first year and for those with poorer prognoses, such as those newly diagnosed with heart failure in the hospital. In addition, SGLT2 inhibitors doubled the risk for genital infections (RR, 2.69 [CI, 1.61 to 4.52]; high certainty).

LIMITATION:

Covariates were unavailable in meta-analyses with reconstructed individual patient data.

CONCLUSION:

Among people with heart failure, SGLT2 inhibitors reduce hospitalizations for heart failure regardless of the presence of diabetes; absolute benefits are most pronounced in first-year treatment and vary with prognostic factors. Clinicians should note the increased risk for genital infection in patients receiving SGLT2 inhibitors. PRIMARY FUNDING SOURCE 1.3.5 Project for Disciplines of Excellence, West China Hospital of Sichuan University. (PROSPERO CRD42021255544).
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Diabetes Mellitus Tipo 2 / Inibidores do Transportador 2 de Sódio-Glicose / Insuficiência Cardíaca Tipo de estudo: Clinical_trials / Prognostic_studies / Systematic_reviews Limite: Humans Idioma: En Revista: Ann Intern Med Ano de publicação: 2022 Tipo de documento: Article
Texto completo
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Diabetes Mellitus Tipo 2 / Inibidores do Transportador 2 de Sódio-Glicose / Insuficiência Cardíaca Tipo de estudo: Clinical_trials / Prognostic_studies / Systematic_reviews Limite: Humans Idioma: En Revista: Ann Intern Med Ano de publicação: 2022 Tipo de documento: Article