Neutral effects of SGLT2 inhibitors in acute coronary syndromes, peripheral arterial occlusive disease, or ischemic stroke: a meta-analysis of randomized controlled trials
Abstract Background Patients with type 2 diabetes are at increased risk for cardiovascular diseases. Sodium-glucose transport 2 inhibitors (SGLT2i) have been shown to enhance cardiovascular health since their debut as a second-line therapy for diabetes. Acute coronary syndrome (ACS), peripheral arte...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-03-01
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| Series: | Cardiovascular Diabetology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12933-023-01789-5 |
| _version_ | 1797865597229334528 |
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| author | Pei-Chien Tsai Wei-Jung Chuang Albert Min-Shan Ko Jui-Shuan Chen Cheng-Hsun Chiu Chun-Han Chen Yung-Hsin Yeh |
| author_facet | Pei-Chien Tsai Wei-Jung Chuang Albert Min-Shan Ko Jui-Shuan Chen Cheng-Hsun Chiu Chun-Han Chen Yung-Hsin Yeh |
| author_sort | Pei-Chien Tsai |
| collection | DOAJ |
| description | Abstract Background Patients with type 2 diabetes are at increased risk for cardiovascular diseases. Sodium-glucose transport 2 inhibitors (SGLT2i) have been shown to enhance cardiovascular health since their debut as a second-line therapy for diabetes. Acute coronary syndrome (ACS), peripheral arterial occlusive disease (PAOD), and ischemic stroke (IS) are types of atherosclerotic cardiovascular disease (ASCVD), although the benefits of treating these disorders have not been shown consistently. Methods We searched four databases (PubMed, Embase, the Cochrane library, and clinicaltrial.gov) for randomized clinical trials (RCTs) until November of 2022. Comparisons were made between SGLT2i-treated and control individuals with type 2 diabetes. Primary outcomes were ACS, PAOD, and IS; secondary outcomes included cardiovascular mortality and all-cause mortality. Risk ratio (RR) and 95% confidence intervals (CI) were determined using a fixed effects model. Cochrane's risk-of-bias (RoB2) instrument was used to assess the validity of each study that met the inclusion criteria. Results We enrolled 79,504 patients with type 2 diabetes from 43 RCTs. There was no difference in the risk of ACS (RR = 0.97, 95% CI 0.89–1.05), PAOD (RR = 0.98, 95% CI 0.78–1.24), or IS (RR = 0.95, 95% CI 0.79–1.14) among patients who took an SGLT2i compared to those who took a placebo or oral hypoglycemic drugs. Subgroup analysis revealed that none of the SGLT2i treatments (canagliflozin, dapagliflozin, empagliflozin, and ertugliflozin) significantly altered outcomes when analyzed separately. Consistent with prior findings, SGLT2i reduced the risk of cardiovascular mortality (RR = 0.85, 95% CI 0.77–0.93) and all-cause mortality (RR = 0.88, 95% CI 0.82–0.94). Conclusion Our results appear to contradict the mainstream concepts regarding the cardiovascular effects of SGLT2i since we found no significant therapeutic benefits in SGLT2i to reduce the incidence of ACS, PAOD, or IS when compared to placebo or oral hypoglycemic drugs. |
| first_indexed | 2024-04-09T23:11:47Z |
| format | Article |
| id | doaj.art-4217f22f54db41a5860c6436a707aa13 |
| institution | Directory Open Access Journal |
| issn | 1475-2840 |
| language | English |
| last_indexed | 2024-04-09T23:11:47Z |
| publishDate | 2023-03-01 |
| publisher | BMC |
| record_format | Article |
| series | Cardiovascular Diabetology |
| spelling | doaj.art-4217f22f54db41a5860c6436a707aa132023-03-22T10:20:52ZengBMCCardiovascular Diabetology1475-28402023-03-0122111510.1186/s12933-023-01789-5Neutral effects of SGLT2 inhibitors in acute coronary syndromes, peripheral arterial occlusive disease, or ischemic stroke: a meta-analysis of randomized controlled trialsPei-Chien Tsai0Wei-Jung Chuang1Albert Min-Shan Ko2Jui-Shuan Chen3Cheng-Hsun Chiu4Chun-Han Chen5Yung-Hsin Yeh6Department and Graduate Institute of Biomedical Sciences, Chang Gung UniversityMaster’s Program in Clinical Trials and Assessment, Department of Biomedical Sciences, Chang Gung UniversityDepartment and Graduate Institute of Biomedical Sciences, Chang Gung UniversityMaster’s Program in Clinical Trials and Assessment, Department of Biomedical Sciences, Chang Gung UniversityMolecular Infectious Disease Research Center, Chang Gung Memorial HospitalMaster’s Program in Clinical Trials and Assessment, Department of Biomedical Sciences, Chang Gung UniversityCardiovascular Department, Chang Gung Memorial HospitalAbstract Background Patients with type 2 diabetes are at increased risk for cardiovascular diseases. Sodium-glucose transport 2 inhibitors (SGLT2i) have been shown to enhance cardiovascular health since their debut as a second-line therapy for diabetes. Acute coronary syndrome (ACS), peripheral arterial occlusive disease (PAOD), and ischemic stroke (IS) are types of atherosclerotic cardiovascular disease (ASCVD), although the benefits of treating these disorders have not been shown consistently. Methods We searched four databases (PubMed, Embase, the Cochrane library, and clinicaltrial.gov) for randomized clinical trials (RCTs) until November of 2022. Comparisons were made between SGLT2i-treated and control individuals with type 2 diabetes. Primary outcomes were ACS, PAOD, and IS; secondary outcomes included cardiovascular mortality and all-cause mortality. Risk ratio (RR) and 95% confidence intervals (CI) were determined using a fixed effects model. Cochrane's risk-of-bias (RoB2) instrument was used to assess the validity of each study that met the inclusion criteria. Results We enrolled 79,504 patients with type 2 diabetes from 43 RCTs. There was no difference in the risk of ACS (RR = 0.97, 95% CI 0.89–1.05), PAOD (RR = 0.98, 95% CI 0.78–1.24), or IS (RR = 0.95, 95% CI 0.79–1.14) among patients who took an SGLT2i compared to those who took a placebo or oral hypoglycemic drugs. Subgroup analysis revealed that none of the SGLT2i treatments (canagliflozin, dapagliflozin, empagliflozin, and ertugliflozin) significantly altered outcomes when analyzed separately. Consistent with prior findings, SGLT2i reduced the risk of cardiovascular mortality (RR = 0.85, 95% CI 0.77–0.93) and all-cause mortality (RR = 0.88, 95% CI 0.82–0.94). Conclusion Our results appear to contradict the mainstream concepts regarding the cardiovascular effects of SGLT2i since we found no significant therapeutic benefits in SGLT2i to reduce the incidence of ACS, PAOD, or IS when compared to placebo or oral hypoglycemic drugs.https://doi.org/10.1186/s12933-023-01789-5SGLT2 inhibitorCanagliflozinDapagliflozinEmpagliflozinErtugliflozinMeta-analysis |
| spellingShingle | Pei-Chien Tsai Wei-Jung Chuang Albert Min-Shan Ko Jui-Shuan Chen Cheng-Hsun Chiu Chun-Han Chen Yung-Hsin Yeh Neutral effects of SGLT2 inhibitors in acute coronary syndromes, peripheral arterial occlusive disease, or ischemic stroke: a meta-analysis of randomized controlled trials Cardiovascular Diabetology SGLT2 inhibitor Canagliflozin Dapagliflozin Empagliflozin Ertugliflozin Meta-analysis |
| title | Neutral effects of SGLT2 inhibitors in acute coronary syndromes, peripheral arterial occlusive disease, or ischemic stroke: a meta-analysis of randomized controlled trials |
| title_full | Neutral effects of SGLT2 inhibitors in acute coronary syndromes, peripheral arterial occlusive disease, or ischemic stroke: a meta-analysis of randomized controlled trials |
| title_fullStr | Neutral effects of SGLT2 inhibitors in acute coronary syndromes, peripheral arterial occlusive disease, or ischemic stroke: a meta-analysis of randomized controlled trials |
| title_full_unstemmed | Neutral effects of SGLT2 inhibitors in acute coronary syndromes, peripheral arterial occlusive disease, or ischemic stroke: a meta-analysis of randomized controlled trials |
| title_short | Neutral effects of SGLT2 inhibitors in acute coronary syndromes, peripheral arterial occlusive disease, or ischemic stroke: a meta-analysis of randomized controlled trials |
| title_sort | neutral effects of sglt2 inhibitors in acute coronary syndromes peripheral arterial occlusive disease or ischemic stroke a meta analysis of randomized controlled trials |
| topic | SGLT2 inhibitor Canagliflozin Dapagliflozin Empagliflozin Ertugliflozin Meta-analysis |
| url | https://doi.org/10.1186/s12933-023-01789-5 |
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