SGLT2i with ARNi versus RASi in heart failure with reduced ejection fraction: Improved survival and reduced hyperkalemia risk in a real-world cohort study.

IF 2.6 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Jian-Rong Peng, Tien-Hsing Chen, Dong-Yi Chen, Yuan Lin, Tien-Shin Chou, Ning-I Yang, Chao-Yung Wang, Ming-Lung Tsai
{"title":"SGLT2i with ARNi versus RASi in heart failure with reduced ejection fraction: Improved survival and reduced hyperkalemia risk in a real-world cohort study.","authors":"Jian-Rong Peng, Tien-Hsing Chen, Dong-Yi Chen, Yuan Lin, Tien-Shin Chou, Ning-I Yang, Chao-Yung Wang, Ming-Lung Tsai","doi":"10.1016/j.jjcc.2025.09.002","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The management of heart failure with reduced ejection fraction (HFrEF) has advanced with the introduction of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and angiotensin receptor-neprilysin inhibitors (ARNi). However, direct comparisons between combination therapies using SGLT2i plus ARNi versus SGLT2i plus conventional renin-angiotensin system inhibitors (RASi) remain limited.</p><p><strong>Methods: </strong>This retrospective cohort study included 2985 HFrEF patients receiving SGLT2i with either ARNi (n = 1542) or RASi (n = 1443) between 2016 and 2022. Inverse probability of treatment weighting was applied to balance baseline characteristics. The primary outcomes included all-cause mortality, cardiovascular death, heart failure hospitalization (HFH), and renal function decline.</p><p><strong>Results: </strong>Over a median follow-up of 1.1 years, SGLT2i + ARNi was associated with significantly lower all-cause mortality compared to SGLT2i + RASi [hazard ratio (HR): 0.81; 95 % confidence interval (CI): 0.67-0.97]. Risk of cardiovascular death (HR: 0.95; 95 % CI: 0.85-1.0), HFH (subdistribution HR: 0.95; 95 % CI: 0.85-1.06), and renal function decline (subdistribution HR: 0.96; 95 % CI: 0.82-1.13) were comparable between groups. The incidence of hyperkalemia was significantly lower with SGLT2i + ARNi (subdistribution HR: 0.38; 95 % CI: 0.27-0.54). Subgroup analysis revealed a more pronounced survival benefit of SGLT2i + ARNi among patients without heart failure hospitalization in the prior year (HR = 0.58 vs. 0.87; p for interaction = 0.041).</p><p><strong>Conclusion: </strong>Among patients with HFrEF receiving SGLT2i therapy, concomitant use of ARNi was associated with a significant reduction in all-cause mortality, comparable cardiovascular and renal outcomes, and a lower risk of hyperkalemia compared to RASi. These findings support the preferential use of ARNi over RASi as background therapy in SGLT2i-treated HFrEF patients.</p>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":" ","pages":""},"PeriodicalIF":2.6000,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of cardiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jjcc.2025.09.002","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0

Abstract

Background: The management of heart failure with reduced ejection fraction (HFrEF) has advanced with the introduction of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and angiotensin receptor-neprilysin inhibitors (ARNi). However, direct comparisons between combination therapies using SGLT2i plus ARNi versus SGLT2i plus conventional renin-angiotensin system inhibitors (RASi) remain limited.

Methods: This retrospective cohort study included 2985 HFrEF patients receiving SGLT2i with either ARNi (n = 1542) or RASi (n = 1443) between 2016 and 2022. Inverse probability of treatment weighting was applied to balance baseline characteristics. The primary outcomes included all-cause mortality, cardiovascular death, heart failure hospitalization (HFH), and renal function decline.

Results: Over a median follow-up of 1.1 years, SGLT2i + ARNi was associated with significantly lower all-cause mortality compared to SGLT2i + RASi [hazard ratio (HR): 0.81; 95 % confidence interval (CI): 0.67-0.97]. Risk of cardiovascular death (HR: 0.95; 95 % CI: 0.85-1.0), HFH (subdistribution HR: 0.95; 95 % CI: 0.85-1.06), and renal function decline (subdistribution HR: 0.96; 95 % CI: 0.82-1.13) were comparable between groups. The incidence of hyperkalemia was significantly lower with SGLT2i + ARNi (subdistribution HR: 0.38; 95 % CI: 0.27-0.54). Subgroup analysis revealed a more pronounced survival benefit of SGLT2i + ARNi among patients without heart failure hospitalization in the prior year (HR = 0.58 vs. 0.87; p for interaction = 0.041).

Conclusion: Among patients with HFrEF receiving SGLT2i therapy, concomitant use of ARNi was associated with a significant reduction in all-cause mortality, comparable cardiovascular and renal outcomes, and a lower risk of hyperkalemia compared to RASi. These findings support the preferential use of ARNi over RASi as background therapy in SGLT2i-treated HFrEF patients.

SGLT2i联合ARNi与RASi治疗心力衰竭伴射血分数降低:在现实世界队列研究中提高生存率和降低高钾血症风险
背景:随着钠-葡萄糖共转运蛋白-2抑制剂(SGLT2i)和血管紧张素受体-neprilysin抑制剂(ARNi)的引入,心力衰竭伴射血分数降低(HFrEF)的治疗取得了进展。然而,SGLT2i + ARNi与SGLT2i +常规肾素-血管紧张素系统抑制剂(RASi)联合治疗的直接比较仍然有限。方法:本回顾性队列研究纳入了2985例2016年至2022年间伴有ARNi (n = 1542)或RASi (n = 1443)的HFrEF SGLT2i患者。应用治疗加权逆概率来平衡基线特征。主要结局包括全因死亡率、心血管死亡、心力衰竭住院(HFH)和肾功能下降。结果:中位随访时间为1.1 年,与SGLT2i + RASi相比,SGLT2i + ARNi与全因死亡率显著降低相关[危险比(HR): 0.81;95 %置信区间(CI): 0.67-0.97]。两组间心血管死亡风险(HR: 0.95; 95 % CI: 0.85-1.0)、HFH(亚分布HR: 0.95; 95 % CI: 0.85-1.06)和肾功能下降(亚分布HR: 0.96; 95 % CI: 0.82-1.13)具有可比性。SGLT2i + ARNi组高钾血症发生率显著降低(亚分布HR: 0.38; 95% % CI: 0.27-0.54)。亚组分析显示,在前一年没有心力衰竭住院的患者中,SGLT2i + ARNi的生存获益更为明显(HR = 0.58 vs. 0.87;相互作用p = 0.041)。结论:在接受SGLT2i治疗的HFrEF患者中,与RASi相比,同时使用ARNi与全因死亡率、心血管和肾脏预后的显著降低以及高钾血症的风险降低相关。这些发现支持在sgltti治疗的HFrEF患者中优先使用ARNi而不是RASi作为背景治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
Journal of cardiology
Journal of cardiology CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
4.90
自引率
8.00%
发文量
202
审稿时长
29 days
期刊介绍: The official journal of the Japanese College of Cardiology is an international, English language, peer-reviewed journal publishing the latest findings in cardiovascular medicine. Journal of Cardiology (JC) aims to publish the highest-quality material covering original basic and clinical research on all aspects of cardiovascular disease. Topics covered include ischemic heart disease, cardiomyopathy, valvular heart disease, vascular disease, hypertension, arrhythmia, congenital heart disease, pharmacological and non-pharmacological treatment, new diagnostic techniques, and cardiovascular imaging. JC also publishes a selection of review articles, clinical trials, short communications, and important messages and letters to the editor.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信