Meta-analysis Of Efficacy And Safety Of Sodium-glucose Transporter 2 Inhibitors In The Treatment Of Heart Failure With Preserved Ejection Fraction

Objective:To systematically evaluate the efficacy and safety of sodium-glucose cotransporter 2 inhibitor(SGLT2i)in the treatment of heart failure with preserved ejection fraction(HFp EF),and to provide evidence-based medical evidence for the clinical treatment of heart failure with preserved ejection fraction.Methods:Searched databases by computer including Wanfang database,China National Knowledge Infrastructure,VIP database,Sino Med,Pub Med,Cochrane Library,Embase and Web of Science.Randomized controlled trials related to sodium-glucose cotransporter 2 inhibitors in the treatment of heart failure with preserved ejection fraction were comprehensively collected.The retrieval time is from the establishment of the database to February 2023.References were screened according to inclusion and exclusion criteria,and the quality of the included references was assessed according to the Cochrane Manual of Systematic Review 5.1.0 recommended RCT evaluation tools.Meta-analysis was performed using Rev Man 5.4 software,and heterogeneity was evaluated according to Q test results.The sources of heterogeneity were analyzed,and sensitivity analysis was conducted.STATA 17.0 software was used to make funnel plots and Egger’s test results were combined to make qualitative and quantitative analysis of the included literature and evaluate publication bias.Results:A total of 11 literatures without replication were included,including 14575 patients with heart failure with preserved ejection fraction,among which 7467 patients in the experimental group were treated with SGLT2 inhibitors on the basis of standard heart failure treatment,and 7108 patients in the control group.They were given standard heart failure treatment or the same dose of placebo.Efficacy study results: Compared with placebo or standard heart failure treatment,SGLT2 inhibitors significantly reduce the risk of primary endpoint events(cardiovascular death or heart failure readmission)[RR=0.80,95%CI(0.74,0.86),P<0.00001],and can effectively reduce the level of NT-pro BNP [SMD=-5.42,95%CI(-7.30,-3.54),P <0.00001],effectively improve 6-minute walking test [MD=30.3,95%CI(15.23,45.38),P<0.0001].However,no improvement in LVEF[MD=1.60,95%CI(-0.32,3.52),P=0.10]is found in HFp EF patients.Safety analysis shows a higher risk of hypotension during treatment with SGLT2 inhibitors than placebo [RR=1.22,95%CI(1.05,1.41),P=0.010],the risk of hypoglycemia and genitourinary infection are similar to placebo(P>0.05).Conclusion:Meta-analysis shows that SGLT2 inhibitors can reduce the risk of cardiovascular death and hospitalization for heart failure in patients with heart failure with preserved ejection fraction,effectively reduce the level of NT-pro BNP,and improve quality of life.Hypotensive risk are more significant than placebo.