PMID- 38230296
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20240118
IS  - 2220-6124 (Print)
IS  - 2220-6124 (Electronic)
IS  - 2220-6124 (Linking)
VI  - 12
IP  - 5
DP  - 2023 Dec 25
TI  - Heterogeneity in cardiorenal protection by Sodium glucose cotransporter 2 
      inhibitors in heart failure across the ejection fraction strata: Systematic 
      review and meta-analysis.
PG  - 182-200
LID - 10.5527/wjn.v12.i5.182 [doi]
AB  - BACKGROUND: Gliflozins or Sodium glucose cotransporter 2 inhibitors (SGLT2i) are 
      relatively novel antidiabetic medications that have recently been shown to 
      represent favorable effects on patients' cardiorenal outcomes. However, there is 
      shortage of data on potential disparities in this therapeutic effect across 
      different patient subpopulations. AIM: To investigate differential effects of 
      SGLT2i on the cardiorenal outcomes of heart failure patients across left 
      ventricular ejection fraction (LVEF) levels. METHODS: Literature was searched 
      systematically for the large randomized double-blind controlled trials with long 
      enough follow up periods reporting cardiovascular and renal outcomes in their 
      patients regarding heart failure status and LVEF levels. Data were then 
      meta-analyzed after stratification of the pooled data across the LVEF strata and 
      New York Heart Associations (NYHA) classifications for heart failure using Stata 
      software version 17.0. RESULTS: The literature search returned 13 Large clinical 
      trials and 13 post hoc analysis reports. Meta-analysis of the effects of 
      gliflozins on the primary composite outcome showed no significant difference in 
      efficacy across the heart failure subtypes, but higher efficacy were detected in 
      patient groups at lower NYHA classifications (I(2) = 46%, P = 0.02). 
      Meta-analyses across the LVEF stratums revealed that a baseline LVEF lower than 
      30% was associated with enhanced improvement in the primary composite outcome 
      compared to patients with higher LVEF levels at the borderline statistical 
      significance (HR: 0.70, 95%CI: 0.60 to 0.79 vs 0.81, 95%CI: 0.75 to 0.87; 
      respectively, P = 0.06). Composite renal outcome was improved significantly 
      higher in patients with no heart failure than in heart failure patients with 
      preserved ejection fraction (HFpEF) (HR: 0.60, 95%CI: 0.49 to 0.72 vs 0.94, 
      95%CI: 0.74 to 1.13; P = 0.04). Acute renal injury occurred significantly less 
      frequently in heart failure patients with reduced ejection fraction who received 
      gliflozins than in HFpEF (HR: 0.67, 95%CI: 51 to 0.82 vs 0.94, 95%CI: 0.82 to 
      1.06; P = 0.01). Volume depletion was consistently increased in response to 
      SGLT2i in all the subgroups. CONCLUSION: Heart failure patients with lower LVEF 
      and lower NYHA sub-classifications were found to be generally more likely to 
      benefit from therapy with gliflozins. Further research are required to identify 
      patient subgroups representing the highest benefits or adverse events in response 
      to SGLT2i.
CI  - (c)The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights 
      reserved.
FAU - Taheri, Saeed
AU  - Taheri S
AD  - Department of Medicine, New Lahijan Scientific Foundation, Lahijan 4415813166, 
      Iran. taherimd@gmail.com.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - World J Nephrol
JT  - World journal of nephrology
JID - 101610229
PMC - PMC10789083
OTO - NOTNLM
OT  - Cardiovascular
OT  - Heart failure with preserved ejection fraction
OT  - Heart failure with reduced ejection fraction
OT  - Renal outcome
OT  - Sodium glucose cotransporter 2 inhibitors
OT  - efficacy
COIS- Conflict-of-interest statement: No financial support was received by the author. 
      The author has no financial interests on the findings of this study.
EDAT- 2024/01/17 06:42
MHDA- 2024/01/17 06:43
PMCR- 2023/12/25
CRDT- 2024/01/17 03:53
PHST- 2023/05/23 00:00 [received]
PHST- 2023/09/01 00:00 [revised]
PHST- 2023/09/25 00:00 [accepted]
PHST- 2024/01/17 06:43 [medline]
PHST- 2024/01/17 06:42 [pubmed]
PHST- 2024/01/17 03:53 [entrez]
PHST- 2023/12/25 00:00 [pmc-release]
AID - 10.5527/wjn.v12.i5.182 [doi]
PST - ppublish
SO  - World J Nephrol. 2023 Dec 25;12(5):182-200. doi: 10.5527/wjn.v12.i5.182.