SGLT2 Inhibitors in Patients with Heart Failure and Preserved Ejection Fraction: A Systematic Review and Meta-Analysis

Abstract

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Abstract 1

Title: SGLT2 Inhibitors in Patients with Heart Failure and Preserved Ejection Fraction: A Systematic Review and Meta-Analysis

Introduction: Heart failure with preserved ejection fraction (HFpEF) has limited therapeutic options. Sodium-glucose cotransporter-2 (SGLT2) inhibitors have demonstrated benefits in heart failure with reduced ejection fraction, and their efficacy in HFpEF is an area of intense investigation. This review synthesizes the evidence for SGLT2 inhibitors in this population.

Methods: A comprehensive search of MEDLINE, Embase, and CENTRAL was conducted for randomized controlled trials (RCTs). We included studies comparing SGLT2 inhibitors to placebo in patients with HFpEF. The primary outcome was a composite of cardiovascular death or hospitalization for heart failure.

Results: The meta-analysis included five major RCTs. SGLT2 inhibitors significantly reduced the primary composite endpoint compared to placebo. The benefit was consistent across various patient subgroups, including those with and without diabetes. A significant reduction in hospitalizations for heart failure was the main driver of the composite outcome.

Discussion: The findings suggest that SGLT2 inhibitors address key pathophysiological pathways in HFpEF beyond glycemic control, such as diuresis, and improvements in cardiac metabolism and fibrosis. They represent a foundational therapy for this condition.

Conclusion: SGLT2 inhibitors are an effective treatment for reducing cardiovascular death and heart failure hospitalizations in patients with HFpEF.