Sodium-glucose cotransporter 2 inhibitor may not prevent atrial fibrillation in patients with heart failure: a systematic review.
Sodium-glucose cotransporter 2 inhibitor may not prevent atrial fibrillation in patients with heart failure: a systematic review.
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DOI：
10.1186/s12933-023-01860-1
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发表时间：
2023-05-24
影响因子：
9.3
通讯作者：
中科院分区：
文献类型：
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作者：
心房颤动（AF）和心力衰竭（HF）因其相似的病理基础而经常共存。然而，钠-葡萄糖协同转运蛋白 2 抑制剂 (SGLT2i)（一类新型抗心力衰竭药物）是否能降低心力衰竭患者发生房颤的风险仍不清楚。本研究的目的是评估 HF 患者中 SGLT2i 与 AF 之间的关系。对随机对照试验进行荟萃分析，评估 SGLT2i 对心力衰竭患者 AF 的影响。截至 2022 年 11 月 27 日，在 PubMed 和 ClinicalTrails.gov 上检索符合条件的研究。通过 Cochrane 工具评估偏倚风险和证据质量。计算了合格研究中 SGLT2i 与安慰剂的 AF 合并风险比。分析中纳入了总共 10 项符合条件的随机对照试验，检查了 16,579 名患者。 SGLT2i 治疗组的 4.20% (348/8292) 患者发生 AF 事件，安慰剂组 4.57% (379/8287) 患者发生 AF 事件。荟萃分析显示，与安慰剂相比，SGLT2i 并未显着降低心力衰竭患者的房颤风险（RR 0.92；95% CI 0.80–1.06；p = 0.23）。无论 SGLT2i 的类型、心力衰竭的类型以及随访持续时间如何，亚组分析中仍存在类似的结果。目前的证据表明，SGLT2i 可能对心力衰竭患者的房颤风险没有预防作用。尽管心力衰竭是最常见的心脏病之一，并且会增加房颤的风险，但心力衰竭患者房颤的情感预防仍未解决。目前的荟萃分析表明，SGLT2i 对于减少 HF 患者的 AF 可能没有预防作用。如何有效预防和早期发现房颤的发生值得探讨。在线版本包含可在 10.1186/s12933-023-01860-1 获取的补充材料。
Atrial fibrillation (AF) and heart failure (HF) frequently coexist because of their similar pathological basis. However, whether sodium-glucose cotransporter 2 inhibitor (SGLT2i), a novel class of anti-HF medication, decreases the risk of AF in HF patients remains unclear. The aim of this study was to assess the relationship between SGLT2i and AF in HF patients. A meta-analysis of randomized controlled trails evaluating the effects of SGLT2i on AF in HF patients was performed. PubMed and ClinicalTrails.gov were searched for eligible studies until 27 November 2022. The risk of bias and quality of evidence were assessed through the Cochrane tool. Pooled risk ratio of AF for SGLT2i versus placebo in eligible studies was calculated. A total of 10 eligible RCTs examining 16,579 patients were included in the analysis. AF events occurred in 4.20% (348/8292) patients treated with SGLT2i, and in 4.57% (379/8287) patients treated with placebo. Meta-analysis showed that SGLT2i did not significantly reduce the risk of AF (RR 0.92; 95% CI 0.80–1.06; p = 0.23) in HF patients when compared to placebo. Similar results remained in the subgroup analyses, regardless of the type of SGLT2i, the type of HF, and the duration of follow-up. Current evidences showed that SGLT2i may have no preventive effects on the risk of AF in patients with HF. Despite HF being one of the most common heart diseases and conferring increased risk for AF, affective prevention of AF in HF patients is still unresolved. The present meta-analysis demonstrated that SGLT2i may have no preventive effects on reducing AF in patients with HF. How to effectively prevent and early detect the occurrence of AF is worth discussing. The online version contains supplementary material available at 10.1186/s12933-023-01860-1.
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