Abstract：
BACKGROUND: Sodium-glucose co-transporter-2 (SGLT2) inhibitors have been studied in patients with heart failure, type 2 diabetes, chronic kidney disease, atherosclerotic cardiovascular disease, and acute myocardial infarction. Individual trials were powered to study composite outcomes in one disease state. We aimed to evaluate the treatment effect of SGLT2 inhibitors on specific clinical endpoints across multiple demographic and disease subgroups.
METHODS: In this systematic review and meta-analysis, we queried online databases (PubMed, Cochrane CENTRAL, and SCOPUS) up to Feb 10, 2024, for primary and secondary analyses of large trials (n>1000) of SGLT2 inhibitors in patients with heart failure, type 2 diabetes, chronic kidney disease, and atherosclerotic cardiovascular disease (including acute myocardial infarction). Outcomes studied included composite of first hospitalisation for heart failure or cardiovascular death, first hospitalisation for heart failure, cardiovascular death, total (first and recurrent) hospitalisation for heart failure, and all-cause mortality. Effect sizes were pooled using random-effects models. This study is registered with PROSPERO, CRD42024513836.
RESULTS: We included 15 trials (N=100 952). Compared with placebo, SGLT2 inhibitors reduced the risk of first hospitalisation for heart failure by 29% in patients with heart failure (hazard ratio [HR] 0·71 [95% CI 0·67-0·77]), 28% in patients with type 2 diabetes (0·72 [0·67-0·77]), 32% in patients with chronic kidney disease (0·68 [0·61-0·77]), and 28% in patients with atherosclerotic cardiovascular disease (0·72 [0·66-0·79]). SGLT2 inhibitors reduced cardiovascular death by 14% in patients with heart failure (HR 0·86 [95% CI 0·79-0·93]), 15% in patients with type 2 diabetes (0·85 [0·79-0·91]), 11% in patients with chronic kidney disease (0·89 [0·82-0·96]), and 13% in patients with atherosclerotic cardiovascular disease (0·87 [0·78-0·97]). The benefit of SGLT2 inhibitors on both first hospitalisation for heart failure and cardiovascular death was consistent across the majority of the 51 subgroups studied. Notable exceptions included acute myocardial infarction (22% reduction in first hospitalisation for heart failure; no effect on cardiovascular death) and heart failure with preserved ejection fraction (26% reduction in first hospitalisation for heart failure; no effect on cardiovascular death).
CONCLUSIONS: SGLT2 inhibitors reduced heart failure events and cardiovascular death in patients with heart failure, type 2 diabetes, chronic kidney disease, and atherosclerotic cardiovascular disease. These effects were consistent across a wide range of subgroups within these populations. This supports the eligibility of a large population with cardiorenal-metabolic diseases for treatment with SGLT2 inhibitors.
BACKGROUND: None.
METHODS: In this systematic review and meta-analysis, we queried online databases (PubMed, Cochrane CENTRAL, and SCOPUS) up to Feb 10, 2024, for primary and secondary analyses of large trials (n>1000) of SGLT2 inhibitors in patients with heart failure, type 2 diabetes, chronic kidney disease, and atherosclerotic cardiovascular disease (including acute myocardial infarction). Outcomes studied included composite of first hospitalisation for heart failure or cardiovascular death, first hospitalisation for heart failure, cardiovascular death, total (first and recurrent) hospitalisation for heart failure, and all-cause mortality. Effect sizes were pooled using random-effects models. This study is registered with PROSPERO, CRD42024513836.
RESULTS: We included 15 trials (N=100 952). Compared with placebo, SGLT2 inhibitors reduced the risk of first hospitalisation for heart failure by 29% in patients with heart failure (hazard ratio [HR] 0·71 [95% CI 0·67-0·77]), 28% in patients with type 2 diabetes (0·72 [0·67-0·77]), 32% in patients with chronic kidney disease (0·68 [0·61-0·77]), and 28% in patients with atherosclerotic cardiovascular disease (0·72 [0·66-0·79]). SGLT2 inhibitors reduced cardiovascular death by 14% in patients with heart failure (HR 0·86 [95% CI 0·79-0·93]), 15% in patients with type 2 diabetes (0·85 [0·79-0·91]), 11% in patients with chronic kidney disease (0·89 [0·82-0·96]), and 13% in patients with atherosclerotic cardiovascular disease (0·87 [0·78-0·97]). The benefit of SGLT2 inhibitors on both first hospitalisation for heart failure and cardiovascular death was consistent across the majority of the 51 subgroups studied. Notable exceptions included acute myocardial infarction (22% reduction in first hospitalisation for heart failure; no effect on cardiovascular death) and heart failure with preserved ejection fraction (26% reduction in first hospitalisation for heart failure; no effect on cardiovascular death).
CONCLUSIONS: SGLT2 inhibitors reduced heart failure events and cardiovascular death in patients with heart failure, type 2 diabetes, chronic kidney disease, and atherosclerotic cardiovascular disease. These effects were consistent across a wide range of subgroups within these populations. This supports the eligibility of a large population with cardiorenal-metabolic diseases for treatment with SGLT2 inhibitors.
BACKGROUND: None.
摘要：
背景：钠-葡萄糖共转运蛋白-2（SGLT2）抑制剂已经在心力衰竭患者中进行了研究，2型糖尿病,慢性肾病,动脉粥样硬化性心血管疾病，和急性心肌梗塞。个别试验有能力研究一种疾病状态下的复合结局。我们旨在评估SGLT2抑制剂对多个人口统计学和疾病亚组特定临床终点的治疗效果。
方法：在本系统综述和荟萃分析中，我们查询了在线数据库(PubMed，科克伦中部,和SCOPUS）截至2024年2月10日，用于SGLT2抑制剂在心力衰竭患者中的大型试验（n>1000）的主要和次要分析，2型糖尿病,慢性肾病,和动脉粥样硬化性心血管疾病（包括急性心肌梗死）。研究的结果包括因心力衰竭或心血管死亡而首次住院的复合结果，首次因心力衰竭住院，心血管死亡,总（首次和复发性）心力衰竭住院，和全因死亡率。使用随机效应模型汇集效应大小。这项研究在PROSPERO注册，CRD42024513836。
结果：我们纳入了15项试验（N=100952）。与安慰剂相比，SGLT2抑制剂可将心力衰竭患者首次因心力衰竭住院的风险降低29%（风险比[HR]0·71[95%CI0·67-0·77]），2型糖尿病患者占28％（0·72[0·67-0·77]），32％的慢性肾脏病患者（0.68[0.61-0.77]），28％的动脉粥样硬化性心血管疾病患者（0·72[0·66-0·79]）。SGLT2抑制剂可使心力衰竭患者的心血管死亡减少14%（HR0·86[95%CI0·79-0·93]），15％的2型糖尿病患者（0·85[0·79-0·91]），11％的慢性肾脏病患者（0·89[0·82-0·96]），动脉粥样硬化性心血管疾病患者占13％（0·87[0·78-0·97]）。SGLT2抑制剂对心力衰竭和心血管死亡的首次住院的益处在所研究的51个亚组中的大多数中是一致的。值得注意的例外包括急性心肌梗死（心力衰竭首次住院减少22％；对心血管死亡无影响）和射血分数保留的心力衰竭（心力衰竭首次住院减少26％；对心血管死亡无影响）。
结论：SGLT2抑制剂可减少心力衰竭患者的心力衰竭事件和心血管死亡，2型糖尿病,慢性肾病,和动脉粥样硬化性心血管疾病。这些效应在这些群体中的广泛亚组中是一致的。这支持了大量患有心肾代谢疾病的人群使用SGLT2抑制剂治疗的资格。
背景：无。
方法：在本系统综述和荟萃分析中，我们查询了在线数据库(PubMed，科克伦中部,和SCOPUS）截至2024年2月10日，用于SGLT2抑制剂在心力衰竭患者中的大型试验（n>1000）的主要和次要分析，2型糖尿病,慢性肾病,和动脉粥样硬化性心血管疾病（包括急性心肌梗死）。研究的结果包括因心力衰竭或心血管死亡而首次住院的复合结果，首次因心力衰竭住院，心血管死亡,总（首次和复发性）心力衰竭住院，和全因死亡率。使用随机效应模型汇集效应大小。这项研究在PROSPERO注册，CRD42024513836。
结果：我们纳入了15项试验（N=100952）。与安慰剂相比，SGLT2抑制剂可将心力衰竭患者首次因心力衰竭住院的风险降低29%（风险比[HR]0·71[95%CI0·67-0·77]），2型糖尿病患者占28％（0·72[0·67-0·77]），32％的慢性肾脏病患者（0.68[0.61-0.77]），28％的动脉粥样硬化性心血管疾病患者（0·72[0·66-0·79]）。SGLT2抑制剂可使心力衰竭患者的心血管死亡减少14%（HR0·86[95%CI0·79-0·93]），15％的2型糖尿病患者（0·85[0·79-0·91]），11％的慢性肾脏病患者（0·89[0·82-0·96]），动脉粥样硬化性心血管疾病患者占13％（0·87[0·78-0·97]）。SGLT2抑制剂对心力衰竭和心血管死亡的首次住院的益处在所研究的51个亚组中的大多数中是一致的。值得注意的例外包括急性心肌梗死（心力衰竭首次住院减少22％；对心血管死亡无影响）和射血分数保留的心力衰竭（心力衰竭首次住院减少26％；对心血管死亡无影响）。
结论：SGLT2抑制剂可减少心力衰竭患者的心力衰竭事件和心血管死亡，2型糖尿病,慢性肾病,和动脉粥样硬化性心血管疾病。这些效应在这些群体中的广泛亚组中是一致的。这支持了大量患有心肾代谢疾病的人群使用SGLT2抑制剂治疗的资格。
背景：无。
