Effects Of SGLT-2 Inhibitors On The Prognosis Of Patients With Heart Failure With Reduced Ejection Fraction:

Objective:Heart failure(HF)and type 2 diabetes(T2DM)often occur simultaneously.HF is one of the most common cardiovascular diseases and one of the main causes of death in patients with T2DM.Existing therapies can reduce the risk of hospitalization and death in patients with HF and heart failure with reduced ejection fraction(HFrEF),but the prognosis of patients with heart failure remains poor.Previous standard treatment of HF may also produce intolerable adverse reactions.Recent studies have proved that SGLT-2i can improve the risk of the combined endpoint of cardiovascular death and hospitalization for heart failure(HHF)in patients with HFrEF.However,the test power of each trial in the secondary outcome is insufficient,leading to different conclusions.As a continuous emergence of new evidence,it is necessary to conduct a larger population meta-analysis to draw more solid conclusions.Methods:We searched Pubmed,Embase,Cochrane Library,and Clinical Trials.gov,the time limit for literature retrieval was December 30,2020.and finally included three clinical randomized controlled trials(RCTs):DAPA-HF,EMPEROR-Reduced,and SOLOIST-WHF.The endpoints selected in this study included cardiovascular death or hospitalization for heart failure,hospitalization for heart failure,cardiovascular death,all-cause death,and worsening renal function.The risk of bias in the literature was assessed using the Cochrane risk of bias tool.We used relative risk(RR)as the effect size,calculated the 95%confidence interval(CI).All P values are two-sided,with values of P<0.05 being considered statistically significant.The Cochrane Q test and I~2 statistics to assess the heterogeneity between studies.To assess the impact of individual studies on pooled RR,we performed a sensitivity analysis by excluding one study at a time.Results:This study finally included 3 RCTs,including 9696 patients with chronic heart failure with reduced ejection fraction,including 4836 patients in the SGLT-2i group and4860 patients in the placebo group.The average age of the patients was 66.9±10.8 years,the female was 24.9%,the average body mass index was 28.4±5.8 kg/m2,and the average left ventricular ejection fraction was 30.2±8.1%.The combined results showed a 25%reduction in the risk of the primary endpoint in the SGLT-2i group compared with the placebo group(RR 0.75,95%CI 0.70-0.81;P<0.00001);the risk of hospitalization for heart failure was significantly reduced by 30%(RR 0.70,95%CI 0.64-0.77;P<0.00001);the risks of cardiovascular death and all-cause death were reduced by 13%and 12%,respectively,of which the risk of cardiovascular death(RR 0.87,95%CI 0.78-0.98;P=0.02),the risk of death from all causes(RR 0.88,95%CI 0.79-0.98;P=0.02).Compared with placebo,the risk of worsening renal function was significantly reduced by 40%(RR 0.60,95%CI 0.43-0.83;P=0.002).The heterogeneity of effect size between studies in each endpoint was not significant.Conclusion:The results of this study suggested that based on the standardized treatment of heart failure,SGLT-2i can not only prevent heart failure,but also treat patients who have developed heart failure,reduce the risk of cardiovascular death,heart failure hospitalization and all-cause death,and had a favorable safety and tolerability profile.