Please use this identifier to cite or link to this item: https://doi.org/10.1002/ehf2.13822
Title: Can glucose-lowering medications improve outcomes in non-diabetic heart failure patients? A Bayesian network meta-analysis
Authors: Yeong, Trevor
Mai, Aaron Shengting
Lim, Oliver ZH
Ng, Cheng Han
Chin, Yip Han
Tay, Phoebe
Lin, Chaoxing
Muthiah, Mark 
Khoo, Chin Meng 
Dalakoti, Mayank
Loh, Poay-Huan 
Chan, Mark 
Yeo, Tiong-Cheng 
Foo, Roger 
Wong, Raymond 
Chew, Nicholas WS
Lin, Weiqin 
Keywords: Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Cardiovascular System & Cardiology
Heart failure
Sodium-glucose cotransporter 2 inhibitors
Glucagon-like peptide 1 receptor agonists
Metformin
GLP-1 RECEPTOR AGONISTS
CARDIOVASCULAR OUTCOMES
EJECTION FRACTION
SGLT2 INHIBITORS
MORTALITY
LIRAGLUTIDE
EMPAGLIFLOZIN
HOSPITALIZATION
DISEASE
DEATH
Issue Date: 29-Jan-2022
Publisher: WILEY PERIODICALS, INC
Citation: Yeong, Trevor, Mai, Aaron Shengting, Lim, Oliver ZH, Ng, Cheng Han, Chin, Yip Han, Tay, Phoebe, Lin, Chaoxing, Muthiah, Mark, Khoo, Chin Meng, Dalakoti, Mayank, Loh, Poay-Huan, Chan, Mark, Yeo, Tiong-Cheng, Foo, Roger, Wong, Raymond, Chew, Nicholas WS, Lin, Weiqin (2022-01-29). Can glucose-lowering medications improve outcomes in non-diabetic heart failure patients? A Bayesian network meta-analysis. ESC HEART FAILURE 9 (2) : 1338-1350. ScholarBank@NUS Repository. https://doi.org/10.1002/ehf2.13822
Abstract: Aims: The cardioprotective effects of glucose-lowering medications in diabetic patients with heart failure (HF) are well known. Several large randomized controlled trials (RCTs) have recently suggested that the cardioprotective effects of glucose-lowering medications extend to HF patients regardless of diabetic status. The aim of this study was to conduct a Bayesian network meta-analysis to evaluate the impact of various glucose-lowering medications on the outcomes of non-diabetic HF patients. Methods and results: Medline and Embase were searched for RCTs investigating the use of glucose-lowering medications in non-diabetic HF patients in August 2021. Studies were included in accordance with the inclusion and exclusion criteria, and data were extracted with a pre-defined datasheet. Primary outcomes include serum N-terminal prohormone of brain natriuretic peptide (NT-proBNP) levels, left ventricular ejection fraction (LVEF), and maximal oxygen consumption (PVO2). A Bayesian network meta-analysis was performed to compare the effectiveness of different classes of glucose-lowering medications in improving HF outcomes. Risk-of-bias was assessed using Cochrane Risk-of-Bias tool 2.0 for randomized trials (ROB2). Seven RCTs involving 2897 patients were included. Sodium-glucose transporter 2 inhibitor (SGLT2i) was the most favourable in lowering NT-proBNP, with the significant reduction in NT-proBNP when compared with glucagon-like peptide-1 receptor agonists (GLP1-RA) [mean differences (MD): −229.59 pg/mL, 95%-credible intervals (95%-CrI): −238.31 to −220.91], metformin (MD: −237.15 pg/mL, 95%-CrI: −256.19 to −218.14), and placebo (MD: −228.00 pg/mL, 95%-CrI: −233.99 to −221.99). SGLT2i was more effective in improving LVEF for HF with reduced ejection fraction patients relative to GLP1-RA (MD: 8.09%, 95%-CrI: 6.30 to 9.88) and placebo (MD: 6.10%, 95%-CrI: 4.37 to 7.84). SGLT2i and GLP1-RA were more favourable to placebo in improving PVO2, with significant increase of PVO2 at a MD of 1.60 mL/kg/min (95%-CrI: 0.63 to 2.57) and 0.86 mL/kg/min (95%-CrI: 0.66 to 1.06), respectively. All three drugs had comparable safety profiles when compared with placebo. Conclusions: This Bayesian network meta-analysis demonstrated that SGLT2i, when compared with GLP1-RA and metformin, was superior in improving LVEF in HF with reduced ejection fraction patients, as well as improving PVO2 and NT-proBNP in non-diabetic HF patients. Further large-scale prospective studies are needed to confirm these preliminary findings.
Source Title: ESC HEART FAILURE
URI: https://scholarbank.nus.edu.sg/handle/10635/219418
ISSN: 2055-5822
2055-5822
DOI: 10.1002/ehf2.13822
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