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
{"title":"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","authors":"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","doi":"10.1016/j.amjmed.2025.06.039","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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]).</p><p><strong>Conclusions: </strong>SGLT2 inhibitors in MASLD patients were associated with reduced mortality, hospitalization, cardiovascular events, and liver complications, highlighting potential benefits beyond glycemic control.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5000,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"SGLT2 Inhibitors and Cardiovascular Outcomes in Metabolic Dysfunction-Associated Steatotic Liver Disease: A Real-World Retrospective Cohort Study.\",\"authors\":\"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\",\"doi\":\"10.1016/j.amjmed.2025.06.039\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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]).</p><p><strong>Conclusions: </strong>SGLT2 inhibitors in MASLD patients were associated with reduced mortality, hospitalization, cardiovascular events, and liver complications, highlighting potential benefits beyond glycemic control.</p>\",\"PeriodicalId\":50807,\"journal\":{\"name\":\"American Journal of Medicine\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.5000,\"publicationDate\":\"2025-06-24\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"American Journal of Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.amjmed.2025.06.039\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"American Journal of Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.amjmed.2025.06.039","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
SGLT2 Inhibitors and Cardiovascular Outcomes in Metabolic Dysfunction-Associated Steatotic Liver Disease: A Real-World Retrospective Cohort Study.
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.
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.
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