钠-葡萄糖共转运体 2 (SGLT2) 抑制剂对急性心力衰竭患者的疗效和安全性：系统综述和荟萃分析

IF 2.8 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Frontiers in Cardiovascular Medicine Pub Date : 2024-09-11 DOI:10.3389/fcvm.2024.1388337

Jingjin Hou, Li Ren, Qingbin Hou, Xiaodong Jia, Zhu Mei, Jiaxin Xu, Zheming Yang, Yiming Li, Chenghui Yan

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Aggregated risk ratios (RR), mean differences (MD), or standardized mean differences (SMD) were generated for all outcomes, with 95% confidence intervals (CIs), to evaluate the predictive significance of SGLT2 inhibitors in patients with AHF.ResultsWe identified 4,053 patients from 13 studies. Patients experienced a substantial reduction in all-cause mortality (RR = 0.82, 95% CI: 0.70–0.96, P = 0.01), readmission rates (RR = 0.85, 95% CI: 0.74–0.98, P = 0.02), the number of heart failure exacerbation events (RR = 0.69, 95% CI: 0.50–0.95, P = 0.02), and the number of rehospitalization events due to heart failure (RR = 0.71, 95% CI: 0.58–0.86, P &lt; 0.05) in the SGLT2 inhibitors-treatment group compared to a placebo or standard care (control group). SGLT2 inhibitors improved patient quality of life (SMD = −0.24, 95% CI: −0.40 to −0.09, P = 0.002). SGLT2 inhibitors were associated with enhanced diuresis in patients with AHF (MD = 2.83, 95% CI: 1.36–4.29, P &lt; 0.05). 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引用次数: 0

摘要

背景一类名为钠-葡萄糖共转运体 2（SGLT2）抑制剂的新型降糖药物对急性心力衰竭（AHF）的有效性和安全性尚未完全确定。因此，我们试图对使用 SGLT2 抑制剂治疗 AHF 的患者的预后和安全性结果进行比较。我们在 Web of Science、PubMed 和 EMBASE 中进行了广泛搜索，以查找从 SGLT2 抑制剂问世至今评估其在 AHF 中使用情况的随机对照试验和观察性研究。我们汇编了与心血管安全性和预后相关的数据。我们为所有结果生成了综合风险比 (RR)、平均差 (MD) 或标准化平均差 (SMD) 以及 95% 置信区间 (CI)，以评估 SGLT2 抑制剂对 AHF 患者的预测意义。患者的全因死亡率（RR = 0.82，95% CI：0.70-0.96，P = 0.01）、再入院率（RR = 0.85，95% CI：0.74-0.98，P = 0.02）、心衰加重次数（RR = 0.69，95% CI：0.50-0.95，P = 0.02），以及与安慰剂或标准护理（对照组）相比，SGLT2 抑制剂治疗组因心衰而再次住院的次数（RR = 0.71，95% CI：0.58-0.86，P < 0.05）。SGLT2 抑制剂改善了患者的生活质量（SMD = -0.24，95% CI：-0.40 至 -0.09，P = 0.002）。SGLT2 抑制剂与增强 AHF 患者的利尿作用有关（MD = 2.83，95% CI：1.36-4.29，P < 0.05）。总体而言，使用 SGLT2 抑制剂治疗可显著降低血清 NT-proBNP 水平（MD = -497.62，95% CI：-762.02 至 -233.21，P < 0.05），并且不会增加不良事件的发生率（RR = 0.91，95% CI：0.82-1.01，P = 0.06）。结论这项荟萃分析表明，与未接受 SGLT2 抑制剂治疗的患者相比，接受 SGLT2 抑制剂治疗的 AHF 患者预后较好。对AHF患者启用SGLT2抑制剂是安全有效的。系统综述注册https://www.doi.org/10.37766/inplasy2024.9.0015，标识符（INPLASY202490015）。

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Efficacy and safety of sodium-glucose cotransporter 2 (SGLT2) inhibitors in patients with acute heart failure: a systematic review and meta-analysis

BackgroundThe effectiveness and safety of a novel class of hypoglycemic medications known as sodium-glucose cotransporter 2 (SGLT2) inhibitors have not been completely established in relation to acute heart failure (AHF). Consequently, we sought to compare the prognostic and safety outcomes of patients administered SGLT2 inhibitors for the treatment of AHF.MethodsAn extensive search of the Web of Science, PubMed, and EMBASE was conducted for randomized controlled trials and observational studies that have evaluated the use of SGLT2 inhibitors in AHF from the inception of these drugs to the present. We compiled data related to cardiovascular safety and prognosis. Aggregated risk ratios (RR), mean differences (MD), or standardized mean differences (SMD) were generated for all outcomes, with 95% confidence intervals (CIs), to evaluate the predictive significance of SGLT2 inhibitors in patients with AHF.ResultsWe identified 4,053 patients from 13 studies. Patients experienced a substantial reduction in all-cause mortality (RR = 0.82, 95% CI: 0.70–0.96, P = 0.01), readmission rates (RR = 0.85, 95% CI: 0.74–0.98, P = 0.02), the number of heart failure exacerbation events (RR = 0.69, 95% CI: 0.50–0.95, P = 0.02), and the number of rehospitalization events due to heart failure (RR = 0.71, 95% CI: 0.58–0.86, P < 0.05) in the SGLT2 inhibitors-treatment group compared to a placebo or standard care (control group). SGLT2 inhibitors improved patient quality of life (SMD = −0.24, 95% CI: −0.40 to −0.09, P = 0.002). SGLT2 inhibitors were associated with enhanced diuresis in patients with AHF (MD = 2.83, 95% CI: 1.36–4.29, P < 0.05). Overall, treatment with SGLT2 inhibitors significantly reduced the level of serum NT-proBNP (MD = −497.62, 95% CI: −762.02 to −233.21, P < 0.05) and did not increase the incidence of adverse events (RR = 0.91, 95% CI: 0.82–1.01, P = 0.06).ConclusionsThis meta-analysis suggests that treatment with SGLT2 inhibitors is associated with a better prognosis in patients with AHF than in patients not treated with SGLT2 inhibitors. It is safe and effective to initiate SGLT2 inhibitors in patients with AHF.Systematic Review Registrationhttps://www.doi.org/10.37766/inplasy2024.9.0015, identifier (INPLASY202490015).

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来源期刊

Frontiers in Cardiovascular Medicine Medicine-Cardiology and Cardiovascular Medicine

CiteScore

3.80

自引率

11.10%

发文量

3529

审稿时长

14 weeks

期刊介绍： Frontiers? Which frontiers? Where exactly are the frontiers of cardiovascular medicine? And who should be defining these frontiers? At Frontiers in Cardiovascular Medicine we believe it is worth being curious to foresee and explore beyond the current frontiers. In other words, we would like, through the articles published by our community journal Frontiers in Cardiovascular Medicine, to anticipate the future of cardiovascular medicine, and thus better prevent cardiovascular disorders and improve therapeutic options and outcomes of our patients.