SGLT2 inhibition in heart failure more advantageous for women than men

A meta-analysis compared the benefit of heart failure therapy with SGLT2 inhibitors versus placebo in women and men. A significantly greater reduction in the primary composite outcome was determined in women with 24% versus 20% in men.

Currently, SGLT2 inhibitors form part of the guideline-recommended standard-of-care in the treatment of heart failure will various ejection fractions, as they have demonstrated benefits in cardiac and renal protection, independent of HbA1c, blood pressure, weight, and kidney function [1,2]. In heart failure trials, women are mostly underrepresented leading to a lack of sex-specific cardiovascular (CV) outcome data [1,3]. To gain further insight into this matter, Dr Mounica Vorla (University of Louisville School of Medicine, KY, USA) performed a meta-analysis of randomised, placebo-controlled trials that provided results stratified by sex [1]. Pooled risk ratios (RR) for the primary composite outcomes were determined using a random effects model that included data from 11 studies.

For women, this comparison of SGLT inhibition with placebo led to a pooled RR of 0.76 (95% CI 0.69–0.82; P<0.00001). The respective finding for men obtained a pooled RR of 0.80 (95% CI 0.73–0.87; P<0.00001). Furthermore, the results of the meta-analysis observed reductions in all-cause and CV death, along with hospitalisation for heart failure. Of note, the study authors conceded some limitations to their analysis. Among them the lack of patient-level data and heterogeneity between the included trials.

1. 
   
   1. Vorla M, et al. SGLT2 inhibitors in women and cardiovascular outcomes - meta-analysis of sex differences in eleven randomised controlled clinical trials. Session 1039-11, ACC 2024 Scientific Session, 6–8 April, Atlanta, USA.
   2. Rosano G, et al. Card Fail Rev. 2020:6:e31.
   3. Bozkurt B, Khalaf S. Methodist Debakey Cardiovasc J. 2017;13(4):216-223.

Medical writing support was provided by Karin Drooff, MPH
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Posted on 11 April, 202411 April, 2024