SGLT2 Inhibitors and Cardiovascular Outcomes in Metabolic Dysfunction-Associated Steatotic Liver Disease: A Real-World Retrospective Cohort Study.

IF 2.5 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

American Journal of Medicine Pub Date : 2025-06-24 DOI:10.1016/j.amjmed.2025.06.039

Hoang Nhat, Ramzi Ibrahim, Rama Mouhaffel, Mahmoud Abdelnabi, Nazli Begum Ozturk, Amany Elshaer, Eiad Habib, Juan Farina, Chadi Ayoub, Justin Z Lee, Anwar Chahal, Kwan Lee, Reza Arsanjani, Amitoj Singh

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引用次数: 0

Abstract

Introduction: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a prevalent global health issue associated with increased cardiovascular risk. SGLT2 inhibitors offer cardioprotective benefits and may improve MASLD-related outcomes. We aimed to investigate the association between SGLT2 inhibitors use and cardio-hepatic events in patients with MASLD.

Methods: We conducted a retrospective cohort study using the TriNetX Network, including 1,280,057 adults (≥18 years) with MASLD without prior alcohol-associated liver disease between 2014 and 2022. Patients were stratified by SGLT2 inhibitors use. Propensity score matching (1:1, PSM) was performed to balance baseline characteristics between two cohorts. Hazard ratio (HR) with 95% confidence intervals (CIs) were calculated using Cox proportional hazard models.

Results: After PSM, there were 69,970 patients with MASLD per each cohort. Mean follow-up was 3.70±2.08 and 4.14±2.66 years for SGLT2 inhibitor users and non-users, respectively. SGLT2 inhibitor use was associated with lower all-cause mortality (HR 0.600 [95% CI, 0.580-0.621]) and hospitalization (HR 0.788 [0.777-0.800]). Cardiovascular benefits included reduced risks of acute heart failure exacerbation (HR 0.872 [0.849-0.896]), acute myocardial infarction (HR 0.916 [0.882-0.952]), cerebral infarction (HR 0.954 [0.916-0.994]), and cardiac arrest (HR 0.661 [0.609-0.718]). Hepatic outcomes showed lower risks of acute liver failure (HR 0.704 [0.643-0.770]) and cirrhosis (HR 0.898 [0.861-0.936]). Safety analysis revealed a lower incidence of acute kidney injury (HR 0.797 [0.779-0.816]) without significant difference for hypoglycemia (HR 0.963 [0.914-1.014]).

Conclusions: SGLT2 inhibitors in MASLD patients were associated with reduced mortality, hospitalization, cardiovascular events, and liver complications, highlighting potential benefits beyond glycemic control.

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SGLT2抑制剂和代谢功能障碍相关脂肪变性肝病的心血管结局：一项真实世界回顾性队列研究

代谢功能障碍相关的脂肪变性肝病（MASLD）是一种普遍的全球健康问题，与心血管风险增加有关。SGLT2抑制剂具有心脏保护作用，并可能改善masld相关结果。我们的目的是研究MASLD患者使用SGLT2抑制剂与心肝事件之间的关系。方法：我们使用TriNetX网络进行了一项回顾性队列研究，包括2014年至2022年期间无酒精相关肝病的1,280,057例MASLD成人（≥18岁）。根据SGLT2抑制剂的使用情况对患者进行分层。进行倾向评分匹配（1:1，PSM）以平衡两个队列之间的基线特征。采用Cox比例风险模型计算95%置信区间（ci）的风险比（HR）。结果：PSM后，每个队列有69,970例MASLD患者。SGLT2抑制剂使用者和非使用者的平均随访时间分别为3.70±2.08年和4.14±2.66年。使用SGLT2抑制剂与较低的全因死亡率（HR 0.600 [95% CI, 0.580-0.621]）和住院率（HR 0.788[0.777-0.800]）相关。心血管方面的益处包括降低急性心力衰竭加重（HR 0.872[0.849-0.896]）、急性心肌梗死（HR 0.916[0.882-0.952]）、脑梗死（HR 0.954[0.916-0.994]）和心脏骤停（HR 0.661[0.609-0.718]）的风险。肝脏预后显示急性肝功能衰竭（HR 0.704[0.643-0.770]）和肝硬化（HR 0.898[0.861-0.936]）的风险较低。安全性分析显示，急性肾损伤发生率较低（HR 0.797[0.779-0.816]），低血糖发生率无显著差异（HR 0.963[0.914-1.014]）。结论：SGLT2抑制剂在MASLD患者中与降低死亡率、住院率、心血管事件和肝脏并发症相关，突出了血糖控制以外的潜在益处。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Journal of Medicine 医学-医学：内科

CiteScore

6.30

自引率

3.40%

发文量

449

审稿时长

9 days

期刊介绍： The American Journal of Medicine - "The Green Journal" - publishes original clinical research of interest to physicians in internal medicine, both in academia and community-based practice. AJM is the official journal of the Alliance for Academic Internal Medicine, a prestigious group comprising internal medicine department chairs at more than 125 medical schools across the U.S. Each issue carries useful reviews as well as seminal articles of immediate interest to the practicing physician, including peer-reviewed, original scientific studies that have direct clinical significance and position papers on health care issues, medical education, and public policy.