Efficacy of Sodium-Glucose Cotransporter 2 (SGLT2) Inhibitors in Heart Failure With Preserved Ejection Fraction: A Systematic Review
Abstract
Heart failure with preserved ejection fraction (HFpEF) represents a growing clinical challenge with limited therapeutic options. Sodium-glucose cotransporter 2 (SGLT2) inhibitors have recently emerged as a promising intervention; however, their impact across diverse HFpEF populations requires further clarification. We conducted a systematic review of four completed randomized controlled trials (RCTs) - CANDLE (Canagliflozin Anti-inflammatory and Metabolic Effects), EMPEROR-Preserved (Empagliflozin Outcome Trial in Patients with Chronic Heart Failure with Preserved Ejection Fraction), the JCI 2021 Empagliflozin HFpEF trial (a Japan Cardiovascular Initiative study assessing empagliflozin in heart failure with preserved ejection fraction), and a multi-agent SGLT2 inhibitor study (empagliflozin, dapagliflozin, and canagliflozin vs. standard of care) - plus one ongoing multicenter study, HELD-HF (Heart Failure with Preserved Ejection Fraction and Empagliflozin in a Long-term Diabetes Population), encompassing approximately 13,400 participants with HFpEF, to evaluate the efficacy and safety of SGLT2 inhibition. In EMPEROR-Preserved (n = 5,792; median follow-up 26.2 months), empagliflozin reduced heart failure hospitalizations from 11.1% to 8.3% and cardiovascular mortality from 16.2% to 13.4% (hazard ratio (HR) 0.75; 95% confidence interval (CI) 0.68-0.84). In a multi-agent trial (n = 1,253; 18 months), SGLT2 inhibitors lowered cardiovascular mortality (4% vs. 5%) and HF…
How strong is the evidence?
Evidence Hub reads this as a systematic review, 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: 13,400 participants or records.
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