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Adamou A, Chlorogiannis DD, Kyriakoulis IG, Stamatiou I, Koukousaki D, Kardoutsos I, Sagris D, Doehner W, Ntaios G. Sodium-glucose cotransporter-2 inhibitors in heart failure patients across the range of body mass index: a systematic review and meta-analysis of randomized controlled trials. Intern Emerg Med 2024; 19:565-573. [PMID: 38353880 PMCID: PMC10955025 DOI: 10.1007/s11739-024-03532-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/08/2024] [Indexed: 03/21/2024]
Abstract
Sodium-glucose cotransporter-2 (SGLT2) inhibitors improve outcomes in patients with heart failure, with or without diabetes. We sought to assess whether there is an interaction of these effects with body mass index (BMI). A systematic review of the MEDLINE and Scopus databases (last search: November 15th, 2022) was performed according to the PRISMA statement. Studies eligible for this review were randomized control trials (RCTs) with patients with chronic heart failure with either preserved or reduced ejection fraction randomly assigned to SGLT2 inhibitors or placebo. Data were extracted independently by two reviewers. BMI was classified according to the WHO classification into under/normal weight (BMI: < 25 kg/m2), overweight (BMI: 25-29.9 kg/m2), obesity class I (BMI: 30-34.9 kg/m2), and obesity classes II/III (BMI: ≥ 35 kg/m2). All analyses were performed using RevMan 5.4. Among 1461 studies identified in the literature search, 3 were eligible and included in the meta-analysis. Among 14,737 patients (32.2% were women), 7,367 were randomized to an SGLT2 inhibitor (dapagliflozin or empagliflozin) and 7,370 to placebo. There were significantly fewer hospitalizations for HF (OR: 0.70, 95%CI: 0.64-0.76), cardiovascular deaths (OR:0.86, 95%CI: 0.77-0.97) and all-cause deaths (OR:0.90, 95%CI: 0.82-0.98) in the SGLT2 inhibitors group compared to the placebo group, without any interaction with BMI group (test for subgroup differences: x2 = 1.79, p = 0.62; x2 = 0.27, p = 0.97; x2 = 0.39, p = 0.94, respectively). There is no interaction between the efficacy of SGLT2 inhibitors and BMI in patients with HF with either preserved or reduced ejection fraction. SGLT2 inhibitors are associated with improved outcomes regardless of the BMI.Trial registration: PROSPERO ID: CRD42022383643.
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Affiliation(s)
- Anastasia Adamou
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41110, Larissa, Thessaly, Greece
| | | | - Ioannis G Kyriakoulis
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41110, Larissa, Thessaly, Greece
| | - Iliana Stamatiou
- Department of Internal Medicine, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Despoina Koukousaki
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41110, Larissa, Thessaly, Greece
| | - Ioannis Kardoutsos
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41110, Larissa, Thessaly, Greece
| | - Dimitrios Sagris
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41110, Larissa, Thessaly, Greece
| | - Wolfram Doehner
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany
- Department of Cardiology (Virchow Klinikum), German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Universita¨Tsmedizin, Berlin, Germany
- Center for Stroke Research Berlin, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - George Ntaios
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41110, Larissa, Thessaly, Greece.
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Crea F. Sodium–glucose co-transporter 2 inhibition: the saga continues. Eur Heart J 2022; 43:4215-4218. [DOI: 10.1093/eurheartj/ehac590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome , Italy
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart , Rome , Italy
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