DataSheet_3_Patients With Type 2 Diabetes Mellitus and Heart Failure Benefit More From Sodium-Glucose Cotransporter 2 Inhibitor: A Systematic Review and Meta-Analysis.docx

BackgroundPatients with type 2 diabetes mellitus (T2DM) and heart failure (HF) are at higher risk of mortality and hospitalization for heart failure (HHF). A recent study showed that sodium-glucose cotransporter 2 (SGLT-2) inhibitors may be a promising choice.
MethodsWe searched the PubMed, Embase, and Cochrane databases of clinical trials for randomized controlled trials investigating the long-term effects of SGLT-2 inhibitors in patients with T2DM and HF compared with placebo. The primary outcome was cardiovascular death or HHF, and the secondary outcomes included cardiovascular death (CV death), HHF, and all-cause mortality. We also conducted an exploratory analysis and tried to identify the population, which will benefit more from the treatment.
ResultsAfter the study selection, a total of 5 trials, including 4 subgroup analyses, met the eligibility criteria. The results suggested that the use of SGLT-2 inhibitors was associated with a reduction in the incidence of CV death or HHF (HR, 0.69[95%CI, 0.63-0.77], P<0.00001), CV death (HR, 0.80[95%CI, 0.69-0.92], P = 0.001), HHF (HR, 0.67[95%CI, 0.60-0.76], P < 0.00001), and all-cause mortality (HR, 0.74[95%CI, 0.64-0.86], P < 0.0001). Moreover, patients with T2DM and HF may benefit more from the treatment than those with T2DM/HF.
ConclusionThe long-term use of SGLT-2 inhibitors can help reduce the risk of mortality and HHF in patients with T2DM and HF.
Systematic Review RegistrationPROSPERO [https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021233156], identifier [CRD42021233156].

背景：2型糖尿病（type 2 diabetes mellitus, T2DM）合并心力衰竭（heart failure, HF）患者的全因死亡及心力衰竭住院（hospitalization for heart failure, HHF）风险显著升高。近期研究表明，钠-葡萄糖协同转运蛋白2（sodium-glucose cotransporter 2, SGLT-2）抑制剂或为该类患者的潜在治疗选择。
方法：本研究检索PubMed、Embase及Cochrane临床对照试验数据库，筛选旨在评估钠-葡萄糖协同转运蛋白2抑制剂对比安慰剂治疗2型糖尿病合并心力衰竭患者的长期疗效的随机对照试验。本研究的主要结局指标为心血管死亡或心力衰竭住院，次要结局指标包括心血管死亡（cardiovascular death, CV death）、心力衰竭住院及全因死亡率。此外，本研究开展探索性分析，以明确可从该治疗中获益更显著的患者人群。
结果：经文献筛选后，共计5项符合纳入标准的试验（含4项亚组分析）被纳入本研究。分析结果显示，钠-葡萄糖协同转运蛋白2抑制剂的使用可显著降低心血管死亡或心力衰竭住院的发生风险（风险比HR=0.69，95%置信区间CI：0.63~0.77，P<0.00001）、心血管死亡风险（HR=0.80，95%CI：0.69~0.92，P=0.001）、心力衰竭住院风险（HR=0.67，95%CI：0.60~0.76，P<0.00001）及全因死亡率（HR=0.74，95%CI：0.64~0.86，P<0.0001）。进一步分析显示，相较于仅罹患2型糖尿病或心力衰竭的患者，2型糖尿病合并心力衰竭患者可从该治疗中获得更显著的临床获益。
结论：长期使用钠-葡萄糖协同转运蛋白2抑制剂，可降低2型糖尿病合并心力衰竭患者的死亡及心力衰竭住院风险。
系统评价注册信息：PROSPERO数据库（注册网址：https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021233156），注册编号：CRD42021233156。