IMR Press / RCM / Volume 23 / Issue 11 / DOI: 10.31083/j.rcm2311374
Open Access Systematic Review
Efficacy of Sodium-Glucose Cotransporter 2 Inhibitors in Heart Failure with a Preserved Ejection Fraction: A Meta-Analysis of Randomized Controlled Trials
Show Less
1 Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, 400010 Chongqing, China
2 Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, 400016 Chongqing, China
3 Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, 100069 Beijing, China
4 Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, 100070 Beijing, China
*Correspondence:; (Jing Huang)
These authors contributed equally.
Academic Editors: Giuseppe Boriani and Giuseppe Biondi-Zoccai
Rev. Cardiovasc. Med. 2022, 23(11), 374;
Submitted: 28 June 2022 | Revised: 2 September 2022 | Accepted: 15 September 2022 | Published: 31 October 2022
(This article belongs to the Section Cardiovascular Drugs)
Copyright: © 2022 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.

Background: Heart failure is prevalent worldwide. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are effective in heart failure patients with reduced ejection fraction, whether SGLT2i are effective in heart failure with preserved ejection fraction (HFpEF) remains to be determined. Methods: All relevant citations in the PubMed, Embase and Cochrane databases were identified from inception to September, 2022. The primary outcome was a composite endpoint of cardiovascular death and hospitalization for heart failure (HHF). A subgroup analysis was performed according to diabetes mellitus status and the ejection fraction. Secondary endpoints were cardiovascular death, hospitalization for heart failure and all cause death. Results: Seven studies involving 11,604 patients were included in the meta-analysis. Compared with placebo, sodium-glucose cotransporter 2 inhibitors reduced the incidence of the primary outcome by 24%, with an odds ratio (OR) and 95% confidence interval (CI) 0.76 [0.69, 0.84]. For secondary outcomes, sodium-glucose cotransporter 2 inhibitors were associated with a lower incidence of hospitalization for heart failure, but not cardiovascular or all-cause death; the OR and 95% CI were 0.73 [0.66, 0.82], 0.92 [0.81, 1.04], 0.96 [0.88, 1.05], respectively. Conclusions: This study proves the clinical efficacy of SGLT2i for treatment of HFpEF patients with or without diabetes, which was mainly driven by prevention of HHF rather than cardiovascular or all-cause death.

sodium-glucose cotransporter 2 inhibitors
heart failure
preserved ejection fraction
reduced ejection fraction
Fig. 1.
Back to top