Evidence map›Paper›PMID 38768620›Full record

SynthesisThe lancet. Diabetes & endocrinology2024

Effect of SGLT2 inhibitors on heart failure outcomes and cardiovascular death across the cardiometabolic disease spectrum: a systematic review and meta-analysis.

Muhammad Shariq Usman, Deepak L Bhatt, Ishaque Hameed, Stefan D Anker, Alice Y Y Cheng, Adrian F Hernandez, William Schuyler Jones, Muhammad Shahzeb Khan, Mark C Petrie, Jacob A Udell and 2 more

Registry-linked trialAbstract readSystematic ReviewMeta-Analysis
PubMed Publisher
In one paragraph

Synthesis in The lancet. Diabetes & endocrinology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It reports registered trial NCT07465926. Cited by 84 papers, 11 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
84citing papers in PubMed, 11 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT07465926 completed

Associations of Early Add-On GLP-1 Receptor Agonist and SGLT2 Inhibitor Therapy With Mortality and Kidney Outcomes in Adults With Obesity and Type 2 Diabetes Across Cardiovascular-Kidney-Metabolic Stages 2-3: A Target-Trial Emulation

Ran2017Enrolled451,036Registered outcomes12Posted comparisons0ConditionsCardiovascular Disease Risk Factor, Cardiovascular-kidney-metabolic Syndrome, Kidney Disease, Obesity & OverweightArmsGLP-1 receptor agonist, SGLT2 inhibitor
PMID 32114848PMID 38785209PMID 40281304PMID 27295427PMID 41178710PMID 38717747PMID 38777402PMID 39171569PMID 39289339PMID 39291205PMID 39342059PMID 39556396other papers from this trial
Open the trial in the graph
3 · Its place in the literature

Who cites it

84 citing papers in PubMed, 11 syntheses or guidelines pooled it.

  1. Pooled it
  2. The impact of sodium glucose cotransporter-2 inhibitors on ventricular arrhythmia in patients with implantable cardioverter-defibrillators: a meta analysis.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2026
    Pooled it
  3. Pooled it
  4. Guideline
  5. Pooled it
  6. Pooled it
  7. Guideline
  8. Pooled it
  9. Pooled it
  10. Pooled it
  11. Pooled it
  12. Trial
  13. Trial
  14. Trial
  15. Trial
  16. Trial
  17. Trial
  18. Trial
  19. Observational
  20. Review

24 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

12 authors.

Muhammad Shariq UsmanDepartment of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA.
Deepak L BhattMount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Ishaque HameedDepartment of Medicine, Medstar Health, Baltimore, MD, USA.
Stefan D AnkerDepartment of Internal Medicine and Cardiology, Campus Virchow-Klinikum, German Heart Center Charité, Charité-University Medicine Berlin, Corporate Member of Free University Berlin and Humboldt-University Berlin, Berlin, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany; BIH Center for Regenerative Therapies (BCRT), Charité-University Medicine Berlin, Corporate Member of Free University Berlin and Humboldt-University Berlin, Berlin, Germany.
Alice Y Y ChengDepartment of Medicine, Division of Endocrinology and Metabolism, University of Toronto, Toronto, ON, Canada.
Adrian F HernandezDuke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA; Division of Cardiology, Duke University School of Medicine, Durham, NC, USA.
William Schuyler JonesDuke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA; Division of Cardiology, Duke University School of Medicine, Durham, NC, USA.
Muhammad Shahzeb KhanDivision of Cardiology, Duke University School of Medicine, Duke University Medical Center, Durham, NC, USA.
Mark C PetrieSchool of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK.
Jacob A UdellWomen's College Hospital and Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
Tim FriedeDepartment of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.
Javed ButlerBaylor Scott and White Research Institute, Baylor Scott and White Health, Dallas, TX, USA; Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA. Electronic address: javed.butler@bswhealth.org.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundSodium-glucose co-transporter-2 (SGLT2) inhibitors have been studied in patients with heart failure, type 2 diabetes, chronic kidney disease, atherosclerotic cardiovascular disease, and acute myocardial infarction. Individual trials were powered to study composite outcomes in one disease state. We aimed to evaluate the treatment effect of SGLT2 inhibitors on specific clinical endpoints across multiple demographic and disease subgroups.

methodsIn this systematic review and meta-analysis, we queried online databases (PubMed, Cochrane CENTRAL, and SCOPUS) up to Feb 10, 2024, for primary and secondary analyses of large trials (n>1000) of SGLT2 inhibitors in patients with heart failure, type 2 diabetes, chronic kidney disease, and atherosclerotic cardiovascular disease (including acute myocardial infarction). Outcomes studied included composite of first hospitalisation for heart failure or cardiovascular death, first hospitalisation for heart failure, cardiovascular death, total (first and recurrent) hospitalisation for heart failure, and all-cause mortality. Effect sizes were pooled using random-effects models. This study is registered with PROSPERO, CRD42024513836.

findingsWe included 15 trials (N=100 952). Compared with placebo, SGLT2 inhibitors reduced the risk of first hospitalisation for heart failure by 29% in patients with heart failure (hazard ratio [HR] 0·71 [95% CI 0·67-0·77]), 28% in patients with type 2 diabetes (0·72 [0·67-0·77]), 32% in patients with chronic kidney disease (0·68 [0·61-0·77]), and 28% in patients with atherosclerotic cardiovascular disease (0·72 [0·66-0·79]). SGLT2 inhibitors reduced cardiovascular death by 14% in patients with heart failure (HR 0·86 [95% CI 0·79-0·93]), 15% in patients with type 2 diabetes (0·85 [0·79-0·91]), 11% in patients with chronic kidney disease (0·89 [0·82-0·96]), and 13% in patients with atherosclerotic cardiovascular disease (0·87 [0·78-0·97]). The benefit of SGLT2 inhibitors on both first hospitalisation for heart failure and cardiovascular death was consistent across the majority of the 51 subgroups studied. Notable exceptions included acute myocardial infarction (22% reduction in first hospitalisation for heart failure; no effect on cardiovascular death) and heart failure with preserved ejection fraction (26% reduction in first hospitalisation for heart failure; no effect on cardiovascular death).

interpretationSGLT2 inhibitors reduced heart failure events and cardiovascular death in patients with heart failure, type 2 diabetes, chronic kidney disease, and atherosclerotic cardiovascular disease. These effects were consistent across a wide range of subgroups within these populations. This supports the eligibility of a large population with cardiorenal-metabolic diseases for treatment with SGLT2 inhibitors.

fundingNone.

Indexed as

Cardiovascular DiseasesDiabetes Mellitus, Type 2Heart FailureSodium-Glucose Transporter 2 InhibitorsHospitalizationHumansRenal Insufficiency, ChronicSodium-Glucose Transporter 2 Inhibitors

Identifiers

PMID38768620

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.