The impact of sodium glucose cotransporter 2 inhibitors in hypertrophic cardiomyopathy: systematic review and meta-analysis
T Chendey, L Bianchi, S Modumudi, L AfonsoAbstract
Background
Hypertrophic cardiomyopathy (HCM) is a heterogeneous and complex myocardial disorder, which remains a significant cause of heart failure (HF), stroke, arrhythmias and mortality, including sudden cardiac death. Despite recent advances in the medical treatment of HCM with myosin inhibitors, there is still unmet need for an effective and universally available treatment. Sodium Glucose Cotransporter 2 (SGLT2) inhibitors are well-established therapies across the entire spectrum of HF, regardless of status of type 2 diabetes. However, the impact of SGLT2 inhibitors in patients with HCM remains unclear.
Purpose
to evaluate the effects of SGLT2 inhibitors on HF events, mortality and adverse events in patients with HCM.
Methods
We conducted a systematic review and meta-analysis to evaluate the effectiveness and safety of SGLT2 inhibitors in patients with HCM. According to PRISMA guidelines, a systematic search was conducted in PubMed, Embase and Cochrane databases for studies evaluating the use of SGLT2 inhibitors in patients with HCM. The primary endpoints were HF hospitalization and all-cause mortality. Results are reported as risk ratio (RR) with 95% confidence intervals (CI). Statistical analyses were performed using the Review manager with a random-effects model. Heterogeneity was assessed using the I² statistic.
Results
Three studies comprising a total of 5,406 patients were included, of whom 2,523 (50.0%) received SGLT2 inhibitors. Overall, 70.7% of patients were male, and the median age was 64.8 years. The median follow-up duration was 22.3 months. Compared with control, SGLT2 inhibitors were associated with a lower risk of HF hospitalization (RR 0.73; 95%CI: 0.52 to 1.03; p=0.07; I²=58%, Figure 1) and all-cause mortality (RR: 0.35; 95%CI: 0.28 to 0.43; p<0.01; I²=0%, Figure 2). The use of SGLT2 inhibitors was not associated with an increase in adverse events (RR 0.83; 95% CI 0.67-1.03; p = 0.1; I² = 0%).
Conclusion
In this meta-analysis, primarily based on retrospective data, SGLT2 inhibitors were associated with a significant reduction in all-cause mortality in patients with HCM. There was no increase of adverse events on SGLT2 inhibitors. These findings highlight the potential benefit of SGLT2 inhibitors on cardiovascular outcomes, but further dedicated randomized controlled trials are warranted to confirm these results.Figure 1For image description, please refer to the figure legend and surrounding text.Figure 2For image description, please refer to the figure legend and surrounding text.