SGLT-2 inhibitors reduce mortality risk in HF with reduced EF but not in HF with preserved EF

China: In a new study published in Diabetes Research and Clinical Practice it was seen that in individuals with heart failure (HF) with reduced Ejection Fraction (HFrEF), sodium-glucose cotransporter-2 (SGLT-2) inhibitors lowered the risk of cardiac mortality, but not in those with HF with preserved ejection fraction (HFpEF).

In 2015, around 40 million individuals worldwide died as a result of heart failure. The prognosis of HF is quite dismal; the 5-year survival rate of HF patients is around 50%. Most trials examining the efficacy of SGLT-2 inhibitors included cardiac death as a secondary endpoint; hence, most studies lacked statistical power to assess the cardiac death outcome. As a result, Lingyue Zhao and colleagues conducted a meta-analysis to assess the efficacy of SGLT-2 inhibitors in patients with various forms of HF.

PubMed, the Cochrane Library database, and clinicaltrials.gov were searched for randomized controlled trials (RCTs) comparing sodium-glucose cotransporter-2 inhibitors to placebo in patients with HF. For evidence synthesis, a random-effects model was applied. Cardiac death was the main goal.

The key findings of this study were as follows:

1. 13 studies were included in this trial (12 RCTs).

2. Sodium-glucose cotransporter-2 inhibitors decreased the aggregate endpoint of cardiac death or rehospitalization due to HF (HHF) and HHF but not cardiac death in patients with HF with preserved ejection fraction (HFpEF).

3. Sodium-glucose cotransporter-2 inhibitors lowered the overall endpoint of cardiac death or HHF and the specific endpoints of cardiac death and HHF in individuals with HF with reduced EF (HFrEF).

In conclusion, according to the findings of this investigation, the effectiveness of SGLT-2 inhibitors in lowering the risk of cardiac mortality is related to the type of HF. The therapeutic effect of SGLT-2 inhibitors for individuals with HFrEF was extensive, but the advantage of SGLT-2 inhibitors for individuals with HFpEF was limited to lowering the incidence of HHF but not cardiac mortality.

Reference:

Zhao, L., Guo, W., Huang, W., Wang, L., & Huang, S. (2022). Benefit of sodium-glucose cotransporter-2 inhibitors on survival outcome is related to the type of heart failure: A meta-analysis. In Diabetes Research and Clinical Practice (Vol. 187, p. 109871). Elsevier BV. https://doi.org/10.1016/j.diabres.2022.109871