Effects Of SGLT2 Inhibitors On The Prognosis And Prevention In Patient With Chronic Heart Failure

Objective:The effect of sodium-glucose cotransporter 2(SGLT2)inhibitors on the prognosis of patients with chronic heart failure and on the prevention of chronic heart failure in patients with type 2 diabetes is not yet clear.Therefore,we collected evidence in all completed clinical trials to evaluate the effect of the drug on heart failure.Methods:We retrieved from PubMed,Embase,the Cochrane Library database to collected the currently known randomized controlled trials(RCTs)related to SGLT2 inhibitors and heart failure patients or heart failure outcomes.The retrieval time was limited to the date of construction of the database until February 2020.Two reviewers independently identified studies,extracted data,and assessed the quality of evidence.Meta-analyses was performed using RevMan5.3 software and were conducted to calculate risk ratios with 95%confidence intervals.Results:A total of 5 studies,39329 patients were included in this study,of which 21568 patients were treated with SGLT2 inhibitors and 17761 patients were treated with placebo.Compared with the placebo group,the SGLT2 inhibitors treatment group significantly improved KCCQ-CS(RR=1.24,95%CI 1.17,1.32,p<0.00001)and KCCQ-OS score(RR=1.15,95%CI 1.08,1.22,p<0.00001),improving the quality of life for patients with chronic heart failure.However.Compared to the placebo group,the SGLT2 inhibitors group did not significantly reduce NT-proBNP levels,and there was no statistical difference between them(MD=-212.13,95%CI-427.28,3.01,p=0.05).The safety analysis results showed that there was no significant difference in the relative risk of volume depletion event(RR=1.12,95%CI 0.92,1.37,p=0.25)and renal adverse events(RR=0.90,95%CI 0.73,1.11,p=0.03)in the SGLT2 inhibitors-treated group compared with the placebo group.Meanwhile.Analysis of cardiovascular outcomes in patients with type 2 diabetes showed that taking SGLT2 inhibitors effectively reduce the relative risk of the event of hospitalization for heart failure(RR=0.69,95%CI 0.61,0.79,p<0.00001),and a combined event of hospitalization for heart failure or death from cardiovascular causes in patients with type 2 diabetes mellitus(RR=0.77,95%CI 0.68,0.87,p<0.0001)compared with placebo.Conclusion:The combined data shows that treatment with SGLT2 inhibitors will not affect the average NT-proBNP level,but will increase the KCCQ-CS and KCCQ-OS scores,which indicates that the health status and quality of life associated with heart failure for patients with chronic heart failure has improved significantly.Compared with placebo,SGLT2 inhibitors treatment has no significant difference in the effects of severe adverse events in patients with chronic heart failure,and the treatment is relatively safe.SGLT2 inhibitors significantly reduce the incidence of hospitalization for heart failure and death from cardiovascular causes for patients with type 2 diabetes mellitus.