Cardiovascular Outcomes of Sodium-Glucose Cotransporter 2 Inhibitors Across Body Mass Index Spectrum in Patients With Heart Failure: An Updated Systematic Review and Meta-Analysis

Abstract

Sodium-glucose cotransporter 2 (SGLT-2) inhibitors have shown efficacy in improving cardiovascular outcomes in patients with chronic heart failure (HF). However, their impact on HF patients with varying body mass index (BMI) levels remains uncertain. To explore potential interactions between baseline BMI and the cardiovascular benefits of SGLT-2 inhibitors, we conducted a systematic review of studies from PubMed, Scopus, and the Cochrane Library database spanning from inception to March 2024. Eligible studies reported cardiovascular outcomes according to baseline BMI in HF patients treated with SGLT-2 inhibitors. Ultimately, our analysis included 4 studies encompassing 20,723 patients. We conducted separate random-effects meta-analyses for the composite outcome of first hospitalization for HF (HHF) or cardiovascular death (CVD), total HHF, CVD, and all-cause mortality. Compared with placebo, SGLT-2 inhibitors significantly reduced the risk of the composite outcome of first HHF or CVD (hazard ratio = 0.78, 95% confidence interval: 0.72-0.83) and total HHF (hazard ratio = 0.73, 95% confidence interval: 0.61-0.83), with consistent effects observed across different BMI categories (test for subgroup differences: P = 0.63 and P = 0.56, respectively). Furthermore, no statistical heterogeneity was found in the effects of SGLT-2 inhibitors on CVD ( P = 0.84, I 2 = 0%) and all-cause mortality ( P = 0.52, I 2 = 0%) across each baseline BMI subgroup in patients with HF. No significant difference in safety was found between the placebo and SGLT-2 inhibitor arms. In conclusion, our findings suggest that the cardiovascular benefits of SGLT-2 inhibitors seem to be independent of baseline BMI in patients with HF.