Supplementary Material for: Association between BMI and efficacy of SGLT2 inhibitors in patients with heart failure or at risk of heart failure: a meta-analysis based on randomized controlled trials

Introduction: This meta-analysis aimed to investigate the effect of SGLT2 inhibitors on the prognosis in patients with heart failure (HF) or at risk of heart failure across different body mass index (BMI).
Methods: We searched PubMed, Embase, Web of Science, and Cochrane Library for all randomized controlled trials (RCTs) comparing SGLT2 inhibitors with placebo in patients with HF or at risk of HF and extracted relevant data up to April 2023 for meta-analysis.
Results: A total of 29,500 patients were enrolled in the selected five studies. The results showed that patients treated with SGLT2 inhibitors had lower heart failure hospitalization (HHF) or cardiovascular (CV) mortality compared to those taking placebo (hazard ratio (HR)=0.73, p<0.001). Patients taking SGLT2 inhibitors also had a lower all-cause mortality rate than those taking placebo (HR=0.85, p=0.017). In BMI subgroup analysis, the HHF rate in the experimental group was lower than that in the control group at BMI ≤24.9 kg/m2, 25.0-29.9 kg/m2, and ≥30.0 kg/m2. There was no significant difference in CV mortality between the two groups at BMI ≤24.9 kg/m2 (HR=0.91, p=0.331) and 25.0-29.9 kg/m2 (HR=0.92, p=0.307). However, when the BMI was ≥30.0 kg/m2, CV mortality with SGLT2 inhibitors was lower than in the control group (HR=0.79, p=0.002). When patients had a BMI ≤24.9 kg/m2 (HR=0.85, p=0.033) and 25.0-29.9 kg/m2 (HR=0.83, p=0.046), the all-cause mortality was lower in the experimental group than in the control group. However, there was no significant difference between the two groups in patients with a BMI ≥30.0 kg/m2 (HR=0.87, p=0.094).
Conclusion: SGLT2 inhibitors improve prognosis in patients with HF or at risk of HF. This effect is affected by BMI.

引言：本项荟萃分析旨在探讨钠-葡萄糖协同转运蛋白2抑制剂(SGLT2 inhibitors)对不同体质量指数(BMI)分层下心力衰竭(HF)患者或心力衰竭风险人群的预后影响。方法：我们检索了PubMed、Embase、Web of Science及Cochrane Library数据库，筛选所有针对心力衰竭或心力衰竭风险人群、比较SGLT2抑制剂与安慰剂的随机对照试验(RCTs)，并提取截至2023年4月的相关数据开展荟萃分析。结果：最终纳入的5项研究共包含29500例受试者。结果显示，与服用安慰剂的对照组相比，接受SGLT2抑制剂治疗的试验组患者心力衰竭住院(HHF)发生率与心血管(CV)死亡率均更低（风险比(HR)=0.73，p<0.001）。同时，试验组患者的全因死亡率亦显著低于对照组（HR=0.85，p=0.017）。在体质量指数亚组分析中，当体质量指数≤24.9 kg/m²、25.0~29.9 kg/m²及≥30.0 kg/m²时，试验组的心力衰竭住院率均低于对照组。在体质量指数≤24.9 kg/m²（HR=0.91，p=0.331）与25.0~29.9 kg/m²（HR=0.92，p=0.307）分层中，两组心血管死亡率无显著差异；而当体质量指数≥30.0 kg/m²时，试验组心血管死亡率显著低于对照组（HR=0.79，p=0.002）。在体质量指数≤24.9 kg/m²（HR=0.85，p=0.033）与25.0~29.9 kg/m²分层中，试验组全因死亡率显著低于对照组；但在体质量指数≥30.0 kg/m²的患者中，两组全因死亡率无显著差异（HR=0.87，p=0.094）。结论：SGLT2抑制剂可改善心力衰竭或心力衰竭风险人群的预后，且该治疗效应受体质量指数的影响。