Sex differences in cardiovascular outcomes of SGLT-2 inhibitors in heart failure randomized controlled trials: A systematic review and meta-analysis
Background: In patients with heart failure (HF), randomized controlled trials (RCTs) of sodium-glucose transporter-2 inhibitors (SGLT-2is) have proven to be effective in decreasing the primary composite outcome of cardiovascular death and hospitalizations for HF. A recently published meta-analysis s...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-02-01
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| Series: | American Heart Journal Plus |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666602223000137 |
| _version_ | 1811166389043462144 |
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| author | Frederick Berro Rivera Vincent Anthony S. Tang Deogracias Villa De Luna Edgar V. Lerma Krishnaswami Vijayaraghavan Amir Kazory Nilay S. Shah Annabelle Santos Volgman |
| author_facet | Frederick Berro Rivera Vincent Anthony S. Tang Deogracias Villa De Luna Edgar V. Lerma Krishnaswami Vijayaraghavan Amir Kazory Nilay S. Shah Annabelle Santos Volgman |
| author_sort | Frederick Berro Rivera |
| collection | DOAJ |
| description | Background: In patients with heart failure (HF), randomized controlled trials (RCTs) of sodium-glucose transporter-2 inhibitors (SGLT-2is) have proven to be effective in decreasing the primary composite outcome of cardiovascular death and hospitalizations for HF. A recently published meta-analysis showed that the use of SGLT-2is among women with diabetes resulted in less reduction in primary composite outcomes compared with men. This study aims to explore potential sex differences in primary composite outcomes among patients with HF treated with SGLT-2is. Methods: We systematically searched the medical database from 2017 to 2022 and retrieved all the RCTs using SGLT-2is with specified cardiovascular outcomes. We used the PRISMA (Preferred Reporting Items for a Review and Meta-analysis) method to screen for eligibility. We evaluated the quality of studies using the Cochrane Risk of Bias tool. We pooled the hazard ratio (HR) of the primary composite outcomes in both sexes, performed a meta-analysis, and calculated the odds ratio (OR) of the primary composite outcomes based on sex. Results: We included 5 RCTs with a total number of 21,947 patients. Of these, 7837 (35.7 %) were females. Primary composite outcomes were significantly lower in males and females taking SGLT-2is compared to placebo (males - HR 0.77; 95 % CI 0.72 to 0.84; p = 0.00001; females - HR 0.75; 95 % CI 0.67 to 0.84; p = 0.00001). Pooled data from four of the RCTs (n = 20,725) revealed a greater occurrence of the primary composite outcomes in females compared with males (OR 1.32; 95 % CI 1.17 to 1.48; p = 0.0002). Conclusion: SGLT-2is reduce the risk of primary composite outcomes in patients with HF, regardless of sex; however, the benefits were less pronounced in women. Further research needs to be done to better explain these observed differences in outcomes. |
| first_indexed | 2024-04-10T15:51:32Z |
| format | Article |
| id | doaj.art-3cf147af27104f94a3427610ddfd1b7a |
| institution | Directory Open Access Journal |
| issn | 2666-6022 |
| language | English |
| last_indexed | 2024-04-10T15:51:32Z |
| publishDate | 2023-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | American Heart Journal Plus |
| spelling | doaj.art-3cf147af27104f94a3427610ddfd1b7a2023-02-11T04:16:33ZengElsevierAmerican Heart Journal Plus2666-60222023-02-0126100261Sex differences in cardiovascular outcomes of SGLT-2 inhibitors in heart failure randomized controlled trials: A systematic review and meta-analysisFrederick Berro Rivera0Vincent Anthony S. Tang1Deogracias Villa De Luna2Edgar V. Lerma3Krishnaswami Vijayaraghavan4Amir Kazory5Nilay S. Shah6Annabelle Santos Volgman7Department of Medicine, Lincoln Medical Center, Bronx, NY, USA; Corresponding author at: Department of Internal Medicine, Lincoln Medical Center, 234 East 149th St., Bronx, NY, USA.Department of Medicine, University of the Philippines – Philippine General Hospital, Metro Manila, PhilippinesDepartment of Internal Medicine, Danbury Hospital, Danbury, CT, USASection of Nephrology, University of Illinois at Chicago College of Medicine/Advocate Christ Medical Center Oak Lawn, IL, USAUniversity of Arizona, AZ, USADivision of Nephrology, Hypertension, and Renal Transplantation, University of Florida, Gainesville, FL, USADepartment of Medicine (Cardiology), Northwestern University Feinberg School of Medicine, Chicago, IL, USADivision of Cardiology, Rush University Medical Center, Chicago, IL, USABackground: In patients with heart failure (HF), randomized controlled trials (RCTs) of sodium-glucose transporter-2 inhibitors (SGLT-2is) have proven to be effective in decreasing the primary composite outcome of cardiovascular death and hospitalizations for HF. A recently published meta-analysis showed that the use of SGLT-2is among women with diabetes resulted in less reduction in primary composite outcomes compared with men. This study aims to explore potential sex differences in primary composite outcomes among patients with HF treated with SGLT-2is. Methods: We systematically searched the medical database from 2017 to 2022 and retrieved all the RCTs using SGLT-2is with specified cardiovascular outcomes. We used the PRISMA (Preferred Reporting Items for a Review and Meta-analysis) method to screen for eligibility. We evaluated the quality of studies using the Cochrane Risk of Bias tool. We pooled the hazard ratio (HR) of the primary composite outcomes in both sexes, performed a meta-analysis, and calculated the odds ratio (OR) of the primary composite outcomes based on sex. Results: We included 5 RCTs with a total number of 21,947 patients. Of these, 7837 (35.7 %) were females. Primary composite outcomes were significantly lower in males and females taking SGLT-2is compared to placebo (males - HR 0.77; 95 % CI 0.72 to 0.84; p = 0.00001; females - HR 0.75; 95 % CI 0.67 to 0.84; p = 0.00001). Pooled data from four of the RCTs (n = 20,725) revealed a greater occurrence of the primary composite outcomes in females compared with males (OR 1.32; 95 % CI 1.17 to 1.48; p = 0.0002). Conclusion: SGLT-2is reduce the risk of primary composite outcomes in patients with HF, regardless of sex; however, the benefits were less pronounced in women. Further research needs to be done to better explain these observed differences in outcomes.http://www.sciencedirect.com/science/article/pii/S2666602223000137SGLT-2 inhibitorsSex differencesCardiovascular outcomesCardiorenalHeart failure |
| spellingShingle | Frederick Berro Rivera Vincent Anthony S. Tang Deogracias Villa De Luna Edgar V. Lerma Krishnaswami Vijayaraghavan Amir Kazory Nilay S. Shah Annabelle Santos Volgman Sex differences in cardiovascular outcomes of SGLT-2 inhibitors in heart failure randomized controlled trials: A systematic review and meta-analysis American Heart Journal Plus SGLT-2 inhibitors Sex differences Cardiovascular outcomes Cardiorenal Heart failure |
| title | Sex differences in cardiovascular outcomes of SGLT-2 inhibitors in heart failure randomized controlled trials: A systematic review and meta-analysis |
| title_full | Sex differences in cardiovascular outcomes of SGLT-2 inhibitors in heart failure randomized controlled trials: A systematic review and meta-analysis |
| title_fullStr | Sex differences in cardiovascular outcomes of SGLT-2 inhibitors in heart failure randomized controlled trials: A systematic review and meta-analysis |
| title_full_unstemmed | Sex differences in cardiovascular outcomes of SGLT-2 inhibitors in heart failure randomized controlled trials: A systematic review and meta-analysis |
| title_short | Sex differences in cardiovascular outcomes of SGLT-2 inhibitors in heart failure randomized controlled trials: A systematic review and meta-analysis |
| title_sort | sex differences in cardiovascular outcomes of sglt 2 inhibitors in heart failure randomized controlled trials a systematic review and meta analysis |
| topic | SGLT-2 inhibitors Sex differences Cardiovascular outcomes Cardiorenal Heart failure |
| url | http://www.sciencedirect.com/science/article/pii/S2666602223000137 |
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