SGLT2 Inhibitors Cardioprotective Even Without Diabetes
NEW YORK (Reuters Health) – Treatment with a sodium-glucose cotransporter-2 inhibitor (SGLT2i) may help keep people with heart failure (HF) out of the hospital and offer protection against cardiovascular disease, regardless of the presence of diabetes, a new analysis shows.
Randomized controlled trials have established the cardiac protection of SGLT2i therapy for adults with type 2 diabetes and new evidence suggests that these results could extend to people without diabetes as well.
To investigate further, researchers from China did a systemic review and meta-analysis of eight randomized controlled trials that evaluated the effect of dapagliflozin, empagliflozin, or canagliflozin in patients with HF regardless of the presence of type 2 diabetes. Altogether, the trials had 15,022 participants.
SGLT2i therapy reduced HF hospitalization by 37% at six months, 32% at one year, and 26% at two years – all with “high certainty” evidence, they report in the Annals of Internal Medicine.
SGLT2i therapy also reduced cardiovascular deaths by 14% at one year, also with high certainty of evidence.
“Nevertheless, low-certainty evidence did not indicate protection against all-cause death, kidney disease progression, or kidney failure,” Dr. Sheyu Li with Sichuan University in Chengdu and colleagues report.
They found the anticipated absolute benefits are greater for patients treated in the first year and for those with poorer prognoses, such as those with newly diagnosed HF.
There were no differences in effectiveness between patients with HF with preserved or reduced ejection fraction, or patients with, versus without, diabetes.
In line with other systematic reviews in patients with type 2 diabetes, SGLT2i therapy doubled the risk for genital infections (relative risk, 2.69; 95% CI: 1.61 to 4.52; high certainty).
“Clinicians should continuously assess the potential benefits against the risks for genital infections and whether the benefits outweigh the harms beyond the first year,” the researchers advise.
“When initiating SGLT2 inhibitor therapy in patients with heart failure, clinicians must consider patient values and preferences in addition to anticipated net benefit for that individual,” they add.
The study had no commercial funding.
SOURCE: https://bit.ly/361sQfq Annals of Internal Medicine, online April 11, 2022.
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