PMID- 33214130
OWN - NLM
STAT- MEDLINE
DCOM- 20210222
LR  - 20210222
IS  - 1097-6744 (Electronic)
IS  - 0002-8703 (Linking)
VI  - 232
DP  - 2021 Feb
TI  - Effect of sodium-glucose cotransporter 2 inhibitors on cardiovascular and kidney 
      outcomes-Systematic review and meta-analysis of randomized placebo-controlled 
      trials.
PG  - 10-22
LID - S0002-8703(20)30350-1 [pii]
LID - 10.1016/j.ahj.2020.10.064 [doi]
AB  - Sodium-glucose cotransporter 2 inhibitor (SGLT2i) use is associated with improved 
      cardiovascular and kidney outcomes. However, the magnitude and potential 
      heterogeneity of effect across patients with varying types of cardiometabolic and 
      kidney disease is unclear. To examine the effect of SGLT2i on cardiovascular and 
      kidney outcomes among patients with type 2 diabetes mellitus (T2DM), and 
      independent of T2DM status, among patients with heart failure (HF), and chronic 
      kidney disease. METHOD: Medline, Embase, Cochrane library and scientific 
      conferences were searched from inception till September 24, 2020 for randomized 
      controlled trials comparing cardiovascular and kidney outcomes between SGLT2i and 
      placebo. Random effects hazard ratios (HR) with 95% confidence intervals (CIs) 
      were calculated. RESULTS: Eight trials with a combined 59,747 patients were 
      included. In the overall population, SGLT2i reduced the risk of all-cause 
      mortality (HR 0.84; 95% CI [0.78-0.91]), cardiovascular mortality (HR 0.84; 95% 
      CI [0.76-0.93]) hospitalization for HF (HR 0.69; 95% CI [0.64-0.74]), myocardial 
      infarction (HR 0.91; 95% CI [0.84-0.99]), and composite kidney outcome (HR 0.62; 
      95% CI [0.56-0.70]). There was no significant effect on the risk of stroke (HR 
      0.98; 95% CI [0.86-1.11]). Results were consistent across subgroups stratified by 
      diabetes and HF status. SGLT2i use was not associated with a greater risk of 
      hypoglycemia (OR 0.92; 95% CI [0.84-1.01]) or amputation (OR 1.25; 95% CI 
      [0.97-1.62]). There were 64 diabetic ketoacidosis events with SGLT2i use and 18 
      with placebo (OR 2.86; 95% CI [1.39-5.86]). CONCLUSIONS: In patients with 
      cardiometabolic and kidney disease, SGLT2i improved cardiovascular and kidney 
      outcomes, regardless of T2DM, HF, and/or CKD status. The magnitude of risk 
      reduction was largest for hospitalization for HF and progression of kidney 
      disease, more modest for mortality and MI and absent for stroke.
CI  - Copyright (c) 2020 Elsevier Inc. All rights reserved.
FAU - Salah, Husam M
AU  - Salah HM
AD  - Division of Cardiology, Department of Medicine, University of Arkansas for 
      Medical Sciences, Little Rock, AR.
FAU - Al'Aref, Subhi J
AU  - Al'Aref SJ
AD  - Division of Cardiology, Department of Medicine, University of Arkansas for 
      Medical Sciences, Little Rock, AR.
FAU - Khan, Muhammad Shahzeb
AU  - Khan MS
AD  - Department of Medicine, University of Mississippi, Jackson, MS.
FAU - Al-Hawwas, Malek
AU  - Al-Hawwas M
AD  - Division of Cardiology, Department of Medicine, University of Arkansas for 
      Medical Sciences, Little Rock, AR.
FAU - Vallurupalli, Srikanth
AU  - Vallurupalli S
AD  - Division of Cardiology, Department of Medicine, University of Arkansas for 
      Medical Sciences, Little Rock, AR.
FAU - Mehta, Jawahar L
AU  - Mehta JL
AD  - Division of Cardiology, Department of Medicine, University of Arkansas for 
      Medical Sciences, Little Rock, AR.
FAU - Mounsey, J Paul
AU  - Mounsey JP
AD  - Division of Cardiology, Department of Medicine, University of Arkansas for 
      Medical Sciences, Little Rock, AR.
FAU - Greene, Stephen J
AU  - Greene SJ
AD  - Division of Cardiology, Department of Medicine, Duke University, Durham, NC; Duke 
      Clinical Research Institute, Durham, NC.
FAU - McGuire, Darren K
AU  - McGuire DK
AD  - Division of Cardiology, Department of Medicine, University Texas Southwestern, 
      and Parkland Health and Hospital System, Dallas, TX.
FAU - Lopes, Renato D
AU  - Lopes RD
AD  - Duke Clinical Research Institute, Durham, NC.
FAU - Fudim, Marat
AU  - Fudim M
AD  - Division of Cardiology, Department of Medicine, Duke University, Durham, NC; Duke 
      Clinical Research Institute, Durham, NC. Electronic address: 
      marat.fudim@duke.edu.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
DEP - 20201024
PL  - United States
TA  - Am Heart J
JT  - American heart journal
JID - 0370465
RN  - 0 (Sodium-Glucose Transporter 2 Inhibitors)
SB  - IM
MH  - Cardiovascular Diseases/mortality
MH  - Diabetes Mellitus, Type 2/complications/*drug therapy
MH  - Diabetic Ketoacidosis/chemically induced/epidemiology
MH  - Heart Failure/complications/*drug therapy
MH  - Hospitalization/statistics & numerical data
MH  - Humans
MH  - Myocardial Infarction/epidemiology
MH  - Proportional Hazards Models
MH  - Randomized Controlled Trials as Topic
MH  - Renal Insufficiency, Chronic/*complications
MH  - Sodium-Glucose Transporter 2 Inhibitors/*therapeutic use
MH  - Stroke/epidemiology
EDAT- 2020/11/21 06:00
MHDA- 2021/02/23 06:00
CRDT- 2020/11/20 05:39
PHST- 2020/10/20 00:00 [received]
PHST- 2020/10/20 00:00 [accepted]
PHST- 2020/11/21 06:00 [pubmed]
PHST- 2021/02/23 06:00 [medline]
PHST- 2020/11/20 05:39 [entrez]
AID - S0002-8703(20)30350-1 [pii]
AID - 10.1016/j.ahj.2020.10.064 [doi]
PST - ppublish
SO  - Am Heart J. 2021 Feb;232:10-22. doi: 10.1016/j.ahj.2020.10.064. Epub 2020 Oct 24.