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Background <p>Cardiomyopathies can present at any age and affect individuals and families across the entire life course. Clinical effects of sodium-glucose cotransporter 2 (SGLT2) inhibitors on cardiomyopathy have not yet been fully elucidated.</p> Objective <p>The primary objective of this study was to investigate whether SGLT2 inhibitors have an effect on cardiomyopathy compared to placebo.</p> Methods <p>We systematically searched for randomized double-blind placebo-controlled trials on PubMed, Web of Science, EU Clinical Trials Register, and ClinicalTrials.gov. We used the Mantel-Haenszel statistical method, fixed-effects model and risk ratio (RR) with 95% confidence intervals (CI) to analyze binary data.</p> Results <p>A total of 19 studies were included, covering 97,035 participants. Compared to placebo, SGLT2 inhibitors were associated with a reduced risk of cardiomyopathy (RR 0.72; 95% CI 0.56–0.92; <i>P</i> &lt; 0.01; high certainty of evidence), with non-significant heterogeneity (P<sub>heterogeneity</sub>=0.81; I<sup>2</sup> = 0%), especially observed in the empagliflozin subgroup (RR 0.66; 95% CI 0.46–0.94; <i>P</i> = 0.02), chronic kidney disease (RR 0.67; 95% CI 0.47–0.97; <i>P</i> = 0.03) population and heart failure (RR 0.46; 95% CI 0.23–0.91; <i>P</i> = 0.03) population. However, in type 2 diabetes mellitus population, the effect of SGLT2 inhibitors on cardiomyopathy incidence was less clear (RR 0.76; 95% CI 0.51–1.12; <i>P</i> = 0.17; moderate certainty of evidence). Additionally, SGLT2 inhibitors were associated with a reduced risk of primary cardiomyopathy (RR 0.43; 95% CI 0.21–0.87; <i>P</i> = 0.02) and slightly decreased the incidence of secondary cardiomyopathy compared to placebo (RR 0.75; 95% CI 0.56–1.01; <i>P</i> = 0.06).</p> Conclusions <p>SGLT2 inhibitors significantly reduced the risk of cardiomyopathy, which further enhances the cardiovascular benefits of SGLT2 inhibitors in clinical settings, especially for patients with heart failure and chronic kidney disease.</p>

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Effects of sodium-glucose cotransporter 2 inhibitors on cardiomyopathy: a meta-analysis

  • 期刊论文

  • 发表日期：

    2025年6月10日

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  • Bo Xu,
  • Tianqiao Zhang,
  • Jiecan Zhou

摘要

Background

Cardiomyopathies can present at any age and affect individuals and families across the entire life course. Clinical effects of sodium-glucose cotransporter 2 (SGLT2) inhibitors on cardiomyopathy have not yet been fully elucidated.

Objective

The primary objective of this study was to investigate whether SGLT2 inhibitors have an effect on cardiomyopathy compared to placebo.

Methods

We systematically searched for randomized double-blind placebo-controlled trials on PubMed, Web of Science, EU Clinical Trials Register, and ClinicalTrials.gov. We used the Mantel-Haenszel statistical method, fixed-effects model and risk ratio (RR) with 95% confidence intervals (CI) to analyze binary data.

Results

A total of 19 studies were included, covering 97,035 participants. Compared to placebo, SGLT2 inhibitors were associated with a reduced risk of cardiomyopathy (RR 0.72; 95% CI 0.56–0.92; P < 0.01; high certainty of evidence), with non-significant heterogeneity (Pheterogeneity=0.81; I2 = 0%), especially observed in the empagliflozin subgroup (RR 0.66; 95% CI 0.46–0.94; P = 0.02), chronic kidney disease (RR 0.67; 95% CI 0.47–0.97; P = 0.03) population and heart failure (RR 0.46; 95% CI 0.23–0.91; P = 0.03) population. However, in type 2 diabetes mellitus population, the effect of SGLT2 inhibitors on cardiomyopathy incidence was less clear (RR 0.76; 95% CI 0.51–1.12; P = 0.17; moderate certainty of evidence). Additionally, SGLT2 inhibitors were associated with a reduced risk of primary cardiomyopathy (RR 0.43; 95% CI 0.21–0.87; P = 0.02) and slightly decreased the incidence of secondary cardiomyopathy compared to placebo (RR 0.75; 95% CI 0.56–1.01; P = 0.06).

Conclusions

SGLT2 inhibitors significantly reduced the risk of cardiomyopathy, which further enhances the cardiovascular benefits of SGLT2 inhibitors in clinical settings, especially for patients with heart failure and chronic kidney disease.