The Safety And Efficacy Of SGLT-2 Inhibitors In Chronic Heart Failure:A Meta-Analysis

Objective: Evidence based medicine was used to evaluate the efficacy and safety of SGLT-2 inhibitor in chronic heart failure.To further explore the efficacy of SGLT-2 inhibitor on heart failure in diabetes grouping and age stratification.In order to provide reference for the clinical treatment of chronic heart failure.Methods: We comprehensively collected and screened relevant randomized controlled trials of chronic heart failure and sglt-2 inhibitors published before September 2021 at home and abroad,including CNKI,WANFANG,VIP,Pub Med,Embase and The Cochrane Library databases.Table method was used to extract relevant data.Efficacy mainly includes cardiovascular mortality,all-cause mortality,composite events of heart failure hospitalization / cardiovascular death and composite event rates of related subgroups.Safety mainly includes the incidence of adverse events such as volume failure,urinary tract infection,fracture and hypoglycemia.Finally,Review Manage version 5.4 software was used for meta-analysis.Results: Seven literatures were selected and a total of 45358 people were included in this study.All of them were multicenter,large-scale randomized controlled trials.The analysis showed that the experimental group（oral SGLT-2 inhibitor group）significantly reduced cardiovascular mortality [RR 0.82,95% CI（0.68,0.98）,P=0.03] and all-cause mortality[RR 0.87,95% CI（0.78,0.97）,compared with the control group（placebo group）.P = 0.010],heart failure hospitalization/cardiovascular death [RR0.78,95%CI（0.75,0.83）,P < 0.00001];By analyzing its subgroups,There was no significant difference in the incidence of compound events（hospitalization for heart failure/cardiovascular death）between patients with diabetes history [RR 0.79,95%CI（0.72,0.86）,P < 0.00001] and patients without diabetes history [RR 0.78,95%CI（0.70,0.87）,P <0.00001].There was significant difference in the incidence of composite events [RR 0.79,95%CI（0.71,0.87）,P<0.00001] in patients aged ≥ 65 years,but there was no significant difference in the incidence of composite events [RR 0.82,95%CI（0.67,1.01）,P=0.07] in patients aged < 65 years;Among the security indicators,Volume failure events [RR 1.07,95%CI（0.97,1.18）,P = 0.20],urinary tract infection events [RR 1.13,95%CI（1.01,1.27）,P = 0.03],fracture events [RR 1.03,95%CI（0.94,1.14）,P =0.51] and the relative risks of hypoglycemic events [RR 0.88,95%CI（0.69,1.11）,P = 0.28] were not statistically significant.Conclusion: SGLT-2i has a protective effect on patients with chronic heart failure（with or without T2DM）and will not increase the incidence of adverse reactions such as volume failure,fracture and hypoglycemia.However,it is necessary to guard against the occurrence of urinary tract infection during use.Secondly,the application of SGLT-2i may have more advantages for the elderly with heart failure ≥ 65 years old,but the conclusion structure is not robust,and the interpretation should be cautious.