Efficacy and Safety of Sodium-Glucose Cotransporter 2 Inhibitors in Heart Transplant Recipients: A Systematic Review and Meta-analyses.

IF 3 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiovascular Drugs Pub Date : 2026-03-20 DOI:10.1007/s40256-026-00792-x

Nelson Luis Cahuapaza-Gutierrez, Cielo Cinthya Calderon-Hernandez, Mariam Miyanay Umeres-Bravo, Tatiana Vanessa Villavicencio-Escudero

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引用次数: 0

Abstract

Background: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have demonstrated efficacy and safety in patients with type 2 diabetes mellitus, chronic kidney disease, and heart failure. However, their effects in heart transplant recipients, a population with high cardiovascular risk, remain poorly understood.

Methods: Clinical trials and observational studies were included. A systematic search was conducted in PubMed, Scopus, EMBASE, and Web of Science. Mean differences (MD) were calculated for continuous outcomes and risk ratios (RR) for binary outcomes, both with 95% confidence intervals (CI). Analyses were performed using RevMan version 5.4.1.

Results: Five retrospective cohort studies including 1512 heart transplant recipients (312 SGLT2i users and 1200 controls) were analyzed. SGLT2i use was not associated with significant changes in renal function (MD in eGFR: 3.96 mL/min/1.73 m²; 95% CI: - 2.33 to 10.26; p = 0.22) or glycemic control (MD in HbA1c: - 0.20%; 95% CI: - 0.73 to 0.34; p = 0.47). Mortality was comparable between groups (RR: 0.64; 95% CI: 0.29-1.40; p = 0.26), with no significant increase in urinary tract infections (RR: 1.40; 95% CI: 0.25-7.72; p = 0.70). However, SGLT2i use was associated with significant reductions in body mass index (MD: - 0.90 kg/m²; 95% CI: - 1.67 to - 0.14; p = 0.02) and systolic blood pressure (MD: - 4.69 mmHg; 95% CI: - 7.27 to - 2.12; p < 0.001).

Conclusions: In heart transplant recipients, the use of SGLT2 inhibitors was not associated with significant improvements in renal function or glycemic control and did not increase mortality or the incidence of urinary tract infections. However, SGLT2 inhibitor therapy was associated with significant reductions in body mass index and systolic blood pressure, suggesting a potential cardiometabolic benefit in this high-risk population. Given that hypertension and obesity are well-established cardiovascular risk factors and that hypertension, in particular, is a common complication among heart transplant recipients, these blood pressure and weight-lowering effects may be clinically meaningful.

Systematic review registration: PROSPERO CRD420251057335.

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钠-葡萄糖共转运蛋白2抑制剂在心脏移植受者中的有效性和安全性：一项系统综述和荟萃分析。

背景：钠-葡萄糖共转运蛋白2抑制剂（SGLT2i）在2型糖尿病、慢性肾病和心力衰竭患者中已被证明是有效和安全的。然而，它们对心脏移植受者（心血管风险高的人群）的影响仍然知之甚少。方法：纳入临床试验和观察性研究。系统检索PubMed、Scopus、EMBASE和Web of Science。计算连续结局的平均差异（MD）和二元结局的风险比（RR），均有95%可信区间（CI）。使用RevMan 5.4.1版本进行分析。结果：五项回顾性队列研究包括1512名心脏移植受者（312名SGLT2i使用者和1200名对照组）进行了分析。SGLT2i的使用与肾功能（eGFR的MD: 3.96 mL/min/1.73 m2; 95% CI: - 2.33至10.26;p = 0.22）或血糖控制（HbA1c的MD: - 0.20%; 95% CI: - 0.73至0.34;p = 0.47）的显著变化无关。两组间死亡率相当（RR: 0.64; 95% CI: 0.29-1.40; p = 0.26），尿路感染无显著增加（RR: 1.40; 95% CI: 0.25-7.72; p = 0.70）。然而，SGLT2i的使用与体重指数（MD: - 0.90 kg/m2; 95% CI: - 1.67至- 0.14;p = 0.02）和收缩压（MD: - 4.69 mmHg; 95% CI: - 7.27至- 2.12;p < 0.001）的显著降低相关。结论：在心脏移植受者中，使用SGLT2抑制剂与肾功能或血糖控制的显著改善无关，也不会增加死亡率或尿路感染的发生率。然而，SGLT2抑制剂治疗与体重指数和收缩压的显著降低相关，表明在这一高危人群中有潜在的心脏代谢益处。鉴于高血压和肥胖是公认的心血管危险因素，特别是高血压是心脏移植受者的常见并发症，这些降压和减肥效果可能具有临床意义。系统评价注册：PROSPERO CRD420251057335。

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 Cardiovascular Drugs 医学-心血管系统

CiteScore

6.70

自引率

3.30%

发文量

审稿时长

>12 weeks

期刊介绍： Promoting rational therapy within the discipline of cardiology, the American Journal of Cardiovascular Drugs covers all aspects of the treatment of cardiovascular disorders, particularly the place in therapy of newer and established agents. Via a program of reviews and original clinical research articles, the journal addresses major issues relating to treatment of these disorders, including the pharmacology, efficacy and adverse effects of the major classes of drugs; information on newly developed drugs and drug classes; the therapeutic implications of latest research into the aetiology of cardiovascular disorders; and the practical management of specific clinical situations. The American Journal of Cardiovascular Drugs offers a range of additional enhanced features designed to increase the visibility, readership and educational value of the journal’s content. Each article is accompanied by a Key Points summary, giving a time-efficient overview of the content to a wide readership. Articles may be accompanied by plain language summaries to assist patients, caregivers and others in understanding important medical advances. The journal also provides the option to include various other types of enhanced features including slide sets, videos and animations. All enhanced features are peer reviewed to the same high standard as the article itself. Peer review is conducted using Editorial Manager®, supported by a database of international experts. This database is shared with other Adis journals.