Association of sodium-glucose co-transporter-2 inhibitors with cardiac outcomes and mortality in cancer patients: A systematic review and meta-analysis.

Abstract

12022 Background: Sodium-glucose co-transporter 2 inhibitors (SGLT2is) have proven effective in improving cardiac outcomes, including heart failure (HF) hospitalizations and cardiovascular mortality. However, data on the role of SGLT2is in cancer patients with diabetes remain limited. Methods: We conducted a systematic review and meta-analysis of studies on patients with concomitant cancer and diabetes to compare cardiac outcomes and mortality between SGLT2i users and non-users. Data were collected from PubMed, Embase, and Cochrane Central databases. Statistical analysis was performed using R Software v4.4.1. A random-effects model was applied to pool risk ratios (RRs) and 95% confidence intervals, with statistical significance set at p < 0.05. Results: Ten studies, with a total of 100,004 patients (mean age = 66.4 years, 47% female), were included. The mean follow-up duration was 2 years. The results showed that cancer patients with diabetes on SGLT2is had significantly reduced all-cause mortality (RR: 0.48; 95% CI: 0.34 to 0.68; p < 0.001; I² = 98%), cancer therapy–related cardiac dysfunction (CTRCD) (RR: 0.68; 95% CI: 0.62 to 0.75; p < 0.001; I² = 0%), and risk of heart failure exacerbation (RR: 0.78; 95% CI: 0.70 to 0.86; p < 0.001; I² = 0%) compared to the control group. However, the incidence of heart failure (HF) (RR: 0.66; 95% CI: 0.22 to 1.96; p = 0.453; I² = 18%) and risk of clinically significant arrhythmias (RR: 0.30; 95% CI: 0.06 to 1.55; p = 0.151; I² = 0%) were comparable between two groups. Conclusions: In cancer patients with diabetes, SGLT2is inhibitors are associated with reduced all-cause mortality, CTRCD, HF incidence, and risk of heart failure exacerbation with a non-significant trend toward HF incidence and clinically significant arrhythmias compared to the control group. Outcome Risk ratios with 95% Confidence Intervals (CI) p-value All-cause mortality 0.48 (0.34 to 0.68) P<0.001 Cancer therapy–related cardiac dysfunction 0.68 (0.62 to 0.75) P<0.001 Heart failure exacerbation 0.78 (0.70 to 0.86) P<0.001 Heart failure incidence 0.66 (0.22 to 1.96) P=0.453 Clinically significant arrhythmias 0.30 (0.06 to 1.55) P=0.151