SGLT2i versus ARNI in heart failure with reduced ejection fraction: a systematic review and meta-analysis

作者全名："Yan, Yuling; Liu, Bin; Du, Jun; Wang, Jing; Jing, Xiaodong; Liu, Yajie; Deng, Songbai; Du, Jianlin; She, Qiang"

作者地址："[Yan, Yuling; Liu, Bin; Du, Jun; Wang, Jing; Jing, Xiaodong; Liu, Yajie; Deng, Songbai; Du, Jianlin; She, Qiang] Chongqing Med Univ, Dept Cardiol, Affiliated Hosp 2, 74 Linjiang Rd, Chongqing 400010, Peoples R China"

通信作者："She, Q (corresponding author), Chongqing Med Univ, Dept Cardiol, Affiliated Hosp 2, 74 Linjiang Rd, Chongqing 400010, Peoples R China."

来源：ESC HEART FAILURE

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:000630968400001

JCR分区：Q2

影响因子：3.8

年份：2021

卷号：8

期号：3

开始页：2210

结束页：2219

文献类型：Review

关键词：Sodium-glucose cotransporter-2 inhibitor; Angiotensin receptor neprilysin inhibitor; Heart failure with reduced ejection fraction; Meta-analysis

摘要："Aims This study aimed to determine the effects of sodium-glucose cotransporter-2 inhibitor (SGLT2i) in heart failure with reduced ejection fraction (HFrEF), compare the effect of SGLT2i with angiotensin receptor neprilysin inhibitor (ARNI), and find whether combination of SGLT2i and ARNI is better than monotherapy. Methods and results Embase, Medline, and Cochrane Central Registry of Controlled Trials were searched for randomized controlled trials evaluating SGLT2i or ARNI in HFrEF. And a total of six trials were included. SGLT2i was found to significantly reduce the risk of cardiovascular death or hospitalization for heart failure by 27% [hazard ratio (HR) 0.73, 95% confidence interval (CI) 0.67-0.80], hospitalization for heart failure by 31% (HR 0.69, 95% CI 0.62-0.77), cardiovascular death by 16% (HR 0.84, 95% CI 0.74-0.95), and all-cause death by 16% (HR 0.84, 95% CI 0.75-0.94) in HFrEF only with a statistically higher risk of genital infection (risk ratio (RR) 2.78, 95% CI 1.46-5.29). The reduction in cardiovascular death or hospitalization for heart failure was of similar magnitude in patients with or without diabetes mellitus (HR 0.71, 95% CI 0.64-0.80 vs. HR 0.75, 95% CI 0.65-0.87) using SGLT2i. Indirect treatment comparison showed that SGLT2i and ARNI had similar effects on primary outcome (HR 0.93, 95% CI 0.82-1.06). And combination of SGLT2i and ARNI achieved a better prognosis performance (HR 0.68, 95% CI 0.53-0.89) compared with ARNI monotherapy. Conclusions SGLT2i could safely reduce cardiovascular death or hospitalization for heart failure in HFrEF regardless of diabetes mellitus status. SGLT2i and ARNI demonstrate similar effects, while combination of SGLT2i and ARNI results in a better cardiovascular protective effect."

基金机构："National Natural Science Foundation of ChinaNational Natural Science Foundation of China (NSFC) [81770251]; National Natural Science Foundation of China Youth Science Fund Project [81800254]; Natural Science Foundation of Chongqing Science and Technology CommissionNatural Science Foundation of Chongqing [cstc2020jcyjmsxmX0210]; medical research project of Chongqing Science and Technology Commission [2021MSXM217, 2020FYYX047]; medical research project of Chongqing Health Committee [2021MSXM217, 2020FYYX047]"

基金资助正文："This work was supported by grants from the National Natural Science Foundation of China (81770251), National Natural Science Foundation of China Youth Science Fund Project (81800254), Natural Science Foundation of Chongqing Science and Technology Commission (cstc2020jcyjmsxmX0210), and medical research projects of Chongqing Science and Technology Commission and Chongqing Health Committee (2021MSXM217, 2020FYYX047)."