Impact of empagliflozin and dapagliflozin on sudden cardiac death: A systematic review and meta-analysis of adjudicated randomized evidence
Abstract
BACKGROUND: Sodium-glucose co-transporter 2 (SGLT2) inhibitors reduce cardiovascular outcomes in the spectrum of cardio-renal-metabolic syndrome. Albeit basic and translational evidence support a putative anti-arrhythmic role, at the clinical level, a lack of consensus has emerged across different studies, and the true impact on sudden cardiac death (SCD) risk remains unclear.
OBJECTIVE: The study aimed to assess the effect of empagliflozin and dapagliflozin on SCD in patients with type 2 diabetes, heart failure, or chronic kidney disease.
METHODS: A systematic review and meta-analysis were conducted on randomized controlled trials. A total of 58,569 participants from 8 trials were included, with 30,565 patients treated with SGLT2 inhibitors and 28,104 controls assigned to placebo. The median follow-up period was 29 months. We performed pooled analysis, meta-regression, and subgroup analyses to explore the impact on SCD risk across different populations and treatment regimens.
RESULTS: The pooled analysis showed a reduced risk of SCD with SGLT2 inhibitors (odds ratio: 0.82; 95% confidence interval: 0.72-0.94; P = .0104), with negligible heterogeneity (τ2 = 0.0000; I2 = 0.0%; Q = 3.17, P = .8687). Subgroup-specific estimates (age, follow-up duration, population, and SGLT2 inhibitor type) did not reach statistical significance. Meta-regression showed no significant moderation by mean age, study duration, or gender. No evidence of publication bias was detected.
CONCLUSION:…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 58,569 participants or records.
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