SGLT2 Inhibitors: A Systematic Review for Heart Failure Treatment

What is it about?

In modern cardiology, SGLT2 inhibitors are crucial components of heart failure treatment. A systematic review assessed 12 randomized controlled trials (RCTs) investigating the effects of SGLT2 inhibitors, particularly canagliflozin, empagliflozin, dapagliflozin, ertugliflozin, and sotagliflozin, in heart failure. The review found significant reductions in three-point MACE (MACE-3), HHF, and renal function across a range of LVEF phenotypes (HFrEF, HFmrEF, and HFpEF). A meta-analytic effect of AF as an adverse event in HF patients following SGLT2 inhibitor treatment was calculated, with no statistically significant difference between the intervention and placebo groups in AF occurrence. However, SGLT2 inhibition, particularly with dapagliflozin, was associated with symptom improvement in HF patients regardless of AF status. The most remarkable findings were from the EMPEROR-Preserved and DELIVER trials, which demonstrated significant results on the effectiveness of dapagliflozin and empagliflozin in reducing the combined risk of worsening HF or cardiovascular death in patients with HF and preserved or mildly reduced ejection fraction.

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Why is it important?

This research is important because it provides a comprehensive systematic review and meta-analysis of randomized controlled trials (RCTs) assessing the effects of sodium-glucose cotransporter 2 (SGLT2) inhibitors, particularly canagliflozin, empagliflozin, dapagliflozin, ertugliflozin, and sotagliflozin, in the treatment of heart failure (HF). These drugs have become critical components of HF treatment algorithms and exert their effects primarily by preventing glucose reabsorption and facilitating its urinary excretion. The review focuses on their effects on atrial fibrillation (AF) as an adverse event in HF patients. Key Takeaways: 1. SGLT2 inhibitors have significant reductions in three-point MACE (MACE-3), HHF, and renal function in patients with HF across the range of phenotypes according to LVEF (HFrEF, HFmrEF, and HFpEF). 2. Dapagliflozin, empagliflozin, and sotagliflozin have demonstrated positive effects on reducing the combined risk of worsening HF or cardiovascular death in patients with HF, regardless of LVEF. 3. The meta-analysis found no statistically significant difference between the intervention and placebo groups in AF occurrence, with no benefit or harm in terms of SGLT2 inhibitors therapy and AF as an adverse event. 4. New evidence suggests that SGLT2 inhibitors, particularly dapagliflozin and empagliflozin, have a positive impact on symptom improvement in HF patients regardless of AF status. 5. The EMPEROR-Preserved and DELIVER trials have shown significant results in reducing the combined risk of worsening HF or cardiovascular death in patients with HF and preserved or mildly reduced ejection fraction.