Comparative Efficacy of Pharmacological Interventions for Heart Failure with Reduced Ejection Fraction Between Asian and White Patients: A Meta-analysis of Randomized Controlled Trials

Abstract

Introduction: Heart failure (HF) poses a significant public health burden in the USA and worldwide, with a higher incidence and disproportionate presentation at a younger age in Asian populations than in other racial and ethnic groups.

Objective: This study aimed to evaluate the treatment efficacy of different HF pharmacological interventions in Asian versus white patients with HF with reduced ejection fraction (HFrEF).

Methods: We conducted a pairwise meta-analysis of randomized controlled trials (RCTs) in adults with HFrEF. We searched the Embase, PubMed, and Cochrane Central Register of Controlled Trials databases from inception to February 9, 2022. We identified RCTs investigating the efficacy of HF drugs, including angiotensin-converting enzyme inhibitors, an angiotensin receptor-neprilysin inhibitor (sacubitril/valsartan), beta-blockers, hyperpolarization-activated cyclic nucleotide-gated channel blockers, sodium-glucose cotransporter 2 (SGLT2) inhibitors, renin inhibitors, vasopressin V2 receptor blockers, and oral soluble guanylate cyclase stimulators. The primary outcome was a composite endpoint of hospitalization of HF, cardiovascular death, and all-cause mortality.

Results: We included 11 RCTs involving 32,654 participants from Asian and white populations. In Asian patients, SGLT2 inhibitors (risk ratio [RR] 0.61; 95% confidence interval [CI] 0.49-0.75) were the most effective in reducing the composite endpoint of hospitalization of HF, followed by hyperpolarization-activated cyclic nucleotide-gated channel blockers (RR 0.62; 95% CI 0.42-0.89). In white patients, beta-blockers (RR 0.68; 95% CI 0.59-0.78) were the most effective in lowering the risk of adverse outcomes, followed by SGLT2 inhibitors (RR 0.72; 95% CI 0.53-0.97). Overall, SGLT2 inhibitors were the most effective treatment in reducing the risk of adverse outcomes among all patients with HFrEF (RR 0.72; 95% CI 0.53-0.97), with a better treatment effect in Asian patients than in their white counterparts (P_interaction = 0.014).

Conclusions: The findings from this study suggest that treatment with SGLT2 inhibitors is effective in lowering the risk of adverse clinical outcomes in patients with HFrEF for both Asian and white populations, with a more pronounced effect in Asian populations. These results highlight the importance of considering racial and ethnic differences in the management of HF.