Effects of sodium-glucose co-transporter inhibitors on individual clinical endpoints and quality of life

Jia Liao; Yang Chen; Zhiyu Ling; Helmut Pürerfellner; Martin Martinek; Michael Derndorfer; Johannes Niel; Ramin Ebrahimi; Matthias Heukäufer; Sarah Janschel; Davide Di Vece; Klaus Empen; Astrid Hummel; Bishwas Chamling; Piotr Futyma; Fahim Ebrahimi; Márcio G Kiuchi; Shaowen Liu; Yuehui Yin; Alexandra Schratter; Willem-Jan Acou; Philipp Sommer; Boris Schmidt; Julian K R Chun; Christian Meyer; Marcus Dörr; Christian Templin; Shaojie Chen

doi:10.1002/ehf2.15136

Effects of sodium-glucose co-transporter inhibitors on individual clinical endpoints and quality of life

ESC Heart Fail. 2024 Nov 20. doi: 10.1002/ehf2.15136. Online ahead of print.

Authors

Jia Liao^{1

2}, Yang Chen¹, Zhiyu Ling¹, Helmut Pürerfellner³, Martin Martinek³, Michael Derndorfer³, Johannes Niel³, Ramin Ebrahimi⁴, Matthias Heukäufer⁴, Sarah Janschel⁴, Davide Di Vece^{4

5}, Klaus Empen⁴, Astrid Hummel⁴, Bishwas Chamling⁴, Piotr Futyma⁶, Fahim Ebrahimi^{7

8

9}, Márcio G Kiuchi¹⁰, Shaowen Liu¹¹, Yuehui Yin¹, Alexandra Schratter¹², Willem-Jan Acou¹³, Philipp Sommer¹⁴, Boris Schmidt¹⁵, Julian K R Chun¹⁵, Christian Meyer^{16

17

18}, Marcus Dörr^{4

19}, Christian Templin⁴, Shaojie Chen⁴

Affiliations

¹ Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
² Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
³ Department for Internal Medicine II, Cardiology, Angiology, and Intensive Care, Akademisches Lehrkrankenhaus, Ordensklinikum Linz Elisabethinen, Linz, Austria.
⁴ Department of Internal Medicine B (Cardiology, Angiology, Pneumology and Internal Intensive Care Medicine), University Medicine Greifswald, Greifswald, Germany.
⁵ University Heart Center, Department of Cardiology, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
⁶ St. Joseph's Heart Rhythm Center, Medical College, University of Rzeszów, Rzeszów, Poland.
⁷ Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
⁸ Department of Gastroenterology and Hepatology, Clarunis University Center for Gastrointestinal and Liver Diseases, Basel, Switzerland.
⁹ Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, University of Basel Hospital, Basel, Switzerland.
¹⁰ School of Medicine-Royal Perth Hospital Unit, University of Western Australia, Perth, Australia.
¹¹ Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
¹² Abteilung für Kardiologie, Klinik Floridsdorf Wien, Vienna, Austria.
¹³ Department of Cardiology, AZ Delta, Roeselare, Belgium.
¹⁴ Klinik für Elektrophysiologie/Rhythmologie, Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen, Germany.
¹⁵ Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany.
¹⁶ Department of Cardiology, Angiology, Intensive Care, cNEP, Cardiac Neuro- & Electrophysiology Research Consortium, EVK Düsseldorf, Düsseldorf, Germany.
¹⁷ German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.
¹⁸ Institute of Neural and Sensory Physiology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
¹⁹ German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany.

PMID: 39564882
DOI: 10.1002/ehf2.15136

Abstract

Aims: Sodium-glucose co-transporter inhibitors (SGLTis) have cardiovascular protective effects. We aimed to assess the effects of SGLTis on individual hard clinical endpoints and quality of life (QoL) in patients with cardiovascular risk factors.

Methods and results: Data was searched in PubMed, Embase, Cochrane Library and clinicaltrials.gov databases up to February 2024. Randomized controlled trials (RCTs) comparing SGLTis with placebo were included. The primary outcomes were individual hard clinical endpoints (Subset A) and QoL (Subset B). For Subset A, 13 RCTs including 90 413 patients were enrolled (age 66 ± 10.1 years, 35.7% female, follow-up 2.4 ± 0.3 years); as compared with placebo, SGLTis were associated with significantly lower risk of all-cause mortality [risk ratio (RR): 0.90, 95% confidence interval (CI): 0.86-0.94, P < 0.01], cardiovascular mortality (RR: 0.87, 95% CI: 0.82-0.92, P < 0.01), hospitalization for heart failure (HF) (RR: 0.72, 95% CI: 0.68-0.76, P < 0.01), HF events (RR: 0.72, 95% CI: 0.68-0.75, P < 0.01), hospitalization for any cause (RR: 0.91, 95% CI: 0.88-0.93, P < 0.01) and myocardial infarction (MI) (RR: 0.92, 95% CI: 0.85-0.99, P = 0.03). Notably, the favourable effect of SGLTis on all-cause mortality was more pronounced in younger (<65 years) patients (RR: 0.86, 95% CI: 0.81-0.92) and in studies with less female (RR: 0.84, 95% CI: 0.79-0.90). The favourable effect of SGLTis on MI was only observed in patients who received sotagliflozin (RR: 0.47, 95% CI: 0.31-0.73). For Subset B, nine RCTs including 2552 HF patients were enrolled (age 67.8 ± 12.4 years, 36.4% female, follow-up 3.4 ± 1.9 months); SGLTis were associated with significant improvement in QoL as compared with placebo.

Conclusions: In patients with a broad spectrum of cardiovascular risk factors, SGLTis substantially improve individual hard clinical outcomes and QoL.

Keywords: cardiovascular outcomes; heart failure (HF); myocardial infarction; quality of life; renal disease; sodium–glucose co‐transporter inhibitors (SGLTis); type 2 diabetes mellitus (T2DM).