The Efficacy And Cardiovascular Outcome Of SGLT2 Inhibitors In The Treatment Of T2DM With Coronary Heart Disease:a Systematic Review And Meta Analysis

Objective:To systematically evaluate the efficacy and cardiovascular outcome of sodium glucose cotransporter 2(SGLT2)inhibitors in the treatment of type 2 diabetes mellitus complicated with coronary heart disease,and to inquire into its possible pathogenesis,so as to provide the theoretical basis for rational drug use in clinical application of type 2 diabetes mellitus.Methods:A comprehensive search of Pub Med,Cochrane Library,Clinical Trials,Embase,China knowledge Network,Wanfang Database and CBM,was conducted until February2021.Patients with type 2 diabetes mellitus complicated with coronary heart disease were collected.Patients in the trial group were treated with SGLT2 inhibitors and those in the control group were given placebo randomized controlled trials(RCT).To determine the inclusion of the literature for data extraction,using Cochrane risk bias assessment tool 5.1.0 for quality evaluation,using Rev Man5.4.1 software for Meta analysis.Results:There were 21216 patients were determined to select 9 terms of RCT.The consequences of meta analysis displayed that the experimental group was better than the control group in reducing the levels of high sensitivity C-reactive protein[WMD=-5.85,95%CI(-10.0～-1.64),P=0.007],fasting insulin[WMD=-1.34,95%CI(-1.71～-0.96),P<0.00001],fasting glucose[WMD=-1.34,95%CI(-1.71 ～-0.96),P<0.00001],glycosylated hemoglobin[WMD=-0.47,95%CI(-0.75～-0.20),P=0.0008],and increasing the level of adiponectin[WMD=2.31,95%CI(1.92～2.70),P<0.00001].The difference between the two was statistically significant.Cardiovascular events: the overall risk of cardiovascular events[RR=0.89,95%CI(0.81～0.97),P<0.01],the occurrence of hospitalization of heart failure[RR=0.69,95%CI(0.62～0.79),P<0.01],the emergence of cardiac infarction[RR=0.88,95%CI(0.80～0.96),P<0.05] and all-cause mortality risk[RR=0.84,95%CI(0.68～0.97),P<0.05]in the test research were distinctly lower than those in the control research,but there was no obvious difference in the incidence of cardiovascular death and stroke between the two researchs.Conclusion:SGLT2 inhibitors used in the therapy of type 2 diabetes mellitus accompanied by coronary heart disease can distinctly enhance fasting blood glucose,glycosylate hemoglobin,insulin levels,reduce hs-CRP,increase adiponectin levels,improve inflammatory response,and have a certain cardiovascular protective effect.