Heart failure & cardiomyopathiesMeta-analysis
Mineralocorticoid receptor antagonists with sodium–glucose co-transporter-2 inhibitors in heart failure: a meta-analysis
- Systematic review and meta-analysis of randomised trials
- fixed-effects
- subgroup analyses
Authors' conclusion
MRAs did not influence SGLT2i effects on the composite of HHF/CVD, HHF or all-cause mortality; however, findings hinted at a more pronounced relative reduction in CVD in chronic HF patients regardless of EF who were randomized to SGLT2i and receiving an MRA compared to those randomized to SGLT2i and not receiving MRAs. SGLT2i attenuated the risk of MRA-associated treatment-emergent hyperkalaemia.
Study context
- Population
- People with heart failure (HF) regardless of ejection fraction (EF), with or without mineralocorticoid receptor antagonist (MRA) use
- Participants
- 21,947 people · 5 studies
- Comparison
- SGLT2 inhibitors vs placebo, by concomitant MRA use
- Outcome
- Composite of:
- First hospitalization or urgent visit for HF/CV death (HHF/CVD)
- HHF
- CVD
Pooled result
As reported in the abstract
SGLT2i vs placebo, by MRA use (MRA vs no MRA)
SGLT2i vs PlaceboHazard ratio (95% CI)
HHF/CVD, MRA users
0.75(0.68–0.81)
HHF/CVD, no MRA
0.79(0.72–0.86)
HHF, MRA users
0.74(0.67–0.83)
HHF, no MRA
0.71(0.63–0.80)
CVD, chronic HF, MRA users
0.81(0.72–0.91)
CVD, chronic HF, no MRA
0.98(0.86–1.13)
Further pooled results
All-cause mortality and adverse renal endpoints, by MRA use
- SGLT2i reduced all-cause mortality regardless of MRA use
- P for interaction = 0.27
- SGLT2i reduced adverse renal endpoints regardless of MRA use
- P for interaction = 0.73
Safety
Volume depletion and hyperkalaemia, by MRA use
- Higher risk of volume depletion with concomitant MRAs
- P for interaction = 0.082
- SGLT2i attenuated MRA-associated mild hyperkalaemia
- P for interaction < 0.001
- SGLT2i attenuated MRA-associated severe hyperkalaemia
- P for interaction = 0.051
Original publication
Mineralocorticoid receptor antagonists with sodium–glucose co-transporter-2 inhibitors in heart failure: a meta-analysis. Eur Heart J. Published 22 August 2023. doi:10.1093/eurheartj/ehad522
Summarised from the published abstract; every number is checked against it