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Sodium-glucose cotransporter 2 inhibitor effects on heart failure hospitalization and cardiac function: systematic review.
Rasalam, Roy; Atherton, John J; Deed, Gary; Molloy-Bland, Michael; Cohen, Neale; Sindone, Andrew.
Afiliación
  • Rasalam R; College of Medicine & Dentistry, James Cook University, Townsville, QLD, Australia.
  • Atherton JJ; Royal Brisbane and Women's Hospital, Faculty of Medicine, University of Queensland, Herston, QLD, Australia.
  • Deed G; Mediwell Medical Clinic, Coorparoo, QLD, Australia.
  • Molloy-Bland M; Oxford PharmaGenesis, Melbourne, VIC, Australia.
  • Cohen N; Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.
  • Sindone A; Concord Hospital, University of Sydney, Concord, NSW, Australia.
ESC Heart Fail ; 8(5): 4093-4118, 2021 10.
Article en En | MEDLINE | ID: mdl-34219407
AIMS: To systematically review randomized controlled trials assessing effects of sodium-glucose cotransporter 2 inhibitors (SGLT2is) on hospitalization for heart failure (HHF) and cardiac structure/function and explore randomized controlled trial (RCT)-derived evidence for SGLT2i efficacy mechanisms in heart failure (HF). METHODS AND RESULTS: Systematic searches of Medline and Embase were performed. In seven trials [3730-17 160 patients; low risk of bias (RoB)], SGLT2is significantly reduced the relative risk of HHF by 27-39% vs. placebo, including in two studies in patients with HF with reduced ejection fraction with or without type-2 diabetes mellitus (T2DM). Improvements in conventional cardiovascular risk factors, including glycaemic levels, cannot account for these effects. Five trials (56-105 patients; low RoB) assessed the effects of 6-12 months of SGLT2i treatment on left ventricular structure/function; four reported significant improvements vs. placebo, and one did not. Five trials (low RoB) assessed SGLT2i treatment effects on serum N-terminal pro B-type natriuretic peptide levels; significant reductions vs. placebo were reported after 8-12 months (two studies; 3730-4744 patients) but not ≤12 weeks (three studies; 80-263 patients). Limited available RCT-derived evidence suggests various possible cardioprotective SGLT2i mechanisms, including improved haemodynamics (natriuresis and reduced interstitial fluid without blood volume contraction/neurohormonal activation) and vascular function, enhanced erythropoiesis, reduced tissue sodium and epicardial fat/inflammation, decreased sympathetic tone, and beneficial changes in cellular energetics. CONCLUSIONS: Sodium-glucose cotransporter 2 inhibitors reduce HHF regardless of T2DM status, and reversal of adverse left ventricular remodelling likely contributes to this efficacy. Hypothesis-driven mechanistic trials remain sparse, although numerous trials are planned or ongoing.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Inhibidores del Cotransportador de Sodio-Glucosa 2 / Insuficiencia Cardíaca Tipo de estudio: Clinical_trials / Etiology_studies / Risk_factors_studies / Systematic_reviews Límite: Humans Idioma: En Revista: ESC Heart Fail Año: 2021 Tipo del documento: Article País de afiliación: Australia Pais de publicación: Reino Unido
Texto completo
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Imprimir
XML
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Inhibidores del Cotransportador de Sodio-Glucosa 2 / Insuficiencia Cardíaca Tipo de estudio: Clinical_trials / Etiology_studies / Risk_factors_studies / Systematic_reviews Límite: Humans Idioma: En Revista: ESC Heart Fail Año: 2021 Tipo del documento: Article País de afiliación: Australia Pais de publicación: Reino Unido