■钠-葡萄糖协同转运蛋白2(SGLT2)抑制剂可降低心力衰竭(HF)患者的复合住院率或心血管死亡率。然而,SGLT2抑制剂在随机试验次要终点和HF患者亚组中的疗效尚不清楚.
■我们对安慰剂对照,SGLT2抑制剂在HF患者中的随机试验。PubMed,Embase,并在Cochrane数据库中搜索了截至2021年1月21日发表的试验。从已发表的报告中提取数据,并根据Cochrane建议进行质量评估。95%CI的危险比(HR)在试验中汇总。感兴趣的主要终点是全因死亡率和心血管死亡率。
■在3969个数据库结果中,纳入15项随机试验和20,241例患者;10,594例(52·3%)接受SGLT2抑制剂治疗。与安慰剂相比,SGLT2抑制剂治疗的患者的全因死亡率(HR0·86;95%CI0·79-0·94;p=0·0007;I2=0%)和心血管死亡率(HR0·86;95%CI0·78-0·96;p=0·006;I2=0%)显着降低。心血管死亡率的复合,HF住院,在以下所有亚组中,SGLT2抑制剂的HF或紧急就诊显着减少:男性,女性,年龄<65,年龄≥65,种族-黑白,估计肾小球滤过率(eGFR)<60,eGFR≥60,纽约心脏协会(NYHA)II级,NYHA≥III,和保留射血分数的HF。
■在HF患者中,与安慰剂相比,SGLT2抑制剂显著降低全因死亡率和心血管死亡率。此外,SGLT2抑制剂在性别亚组中降低了心血管死亡率或HF住院/紧急就诊的组合,年龄,种族,eGFR,HF功能类,和射血分数。
BACKGROUND: Sodium-glucose cotransporter 2 (SGLT2) inhibitors reduce the composite of heart failure (HF) hospitalizations or cardiovascular mortality among patients with HF. However, the efficacy of SGLT2 inhibitors in secondary endpoints of randomized trials and in subgroups of HF patients is not well known.
METHODS: We performed a systematic review and meta-analysis of placebo-controlled, randomized trials of SGLT2 inhibitors in patients with HF. PubMed, Embase, and Cochrane databases were searched for trials published up to January 21, 2021. Data were extracted from published reports and quality assessment was performed per Cochrane recommendations. Hazard ratios (HRs) with 95% CI were pooled across trials. The primary endpoints of interest were all-cause and cardiovascular mortality.
RESULTS: Out of 3969 database results, 15 randomized trials and 20,241 patients were included; 10,594 (52·3%) received SGLT2 inhibitors. All-cause mortality (HR 0·86; 95% CI 0·79-0·94; p = 0·0007; I2=0%) and cardiovascular mortality (HR 0·86; 95% CI 0·78-0·96; p = 0·006; I2=0%) were significantly lower in patients treated with SGLT2 inhibitors compared with placebo. The composite of cardiovascular mortality, HF hospitalizations, or urgent visits for HF was significantly reduced with SGLT2 inhibitors in all the following subgroups: male, female, age < 65, age ≥ 65, race - Black and White, estimated glomerular filtration rate (eGFR) <60, eGFR ≥60, New York Heart Association (NYHA) class II, NYHA ≥III, and HF with preserved ejection fraction.
CONCLUSIONS: In patients with HF, SGLT2 inhibitors significantly reduce all-cause and cardiovascular mortality compared with placebo. In addition, the composite of cardiovascular mortality or HF hospitalizations/urgent visits is reduced with SGLT2 inhibitors across subgroups of sex, age, race, eGFR, HF functional class, and ejection fraction.