Meta-analysis
Sodium-Glucose Cotransporter-2 Inhibitors and Major Adverse Cardiovascular Outcomes: A SMART-C Collaborative Meta-Analysis
- Systematic review and meta-analysis of randomised trials
- collaborative trial-level meta-analysis
- placebo-controlled trials
Authors' conclusion
SGLT2i reduce the risk of MACE across a broad range of patients irrespective of atherosclerotic cardiovascular disease, diabetes, kidney function, or other major clinical characteristics at baseline.
Study context
- Population
- Patients with DM at high risk for atherosclerotic CVD, HF, or CKD in phase 3 placebo-controlled outcomes trials of SGLT2i
- Participants
- 78,607 patients · 11 trials
- Comparison
- SGLT2i vs placebo
- Outcome
- Major adverse cardiovascular events (MACE):
- CV death
- MI
- Stroke
Pooled result
MACE
Hazard ratio
0.91
95% CI 0.87–0.96
P < 0.0001
SGLT2i vs Placebo
HR 0.91 (95% CI 0.87–0.96); P < 0.0001
As reported in the abstract
Further pooled results
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| CV death | 0.86 (0.81–0.92) | P < 0.0001 | |
| MI (overall population) · no significant effect | 0.95 (0.87–1.04) | P = 0.29 | |
| Stroke · no effect | 0.99 (0.91–1.07) | P = 0.77 | |
| 0.512Hazard ratio (log scale) |
HF death
- HF death HR (driver of CV death benefit)
- HR, 0.68 [95% CI, 0.46-1.02]
Sudden cardiac death
- Sudden cardiac death HR (driver of CV death benefit)
- HR, 0.86 [95% CI, 0.78-0.95]
CV death benefit by albuminuria (subgroup)
- Generally consistent across subgroups; possibly more apparent with albuminuria
- P for interaction = 0.02
Original publication
Sodium-Glucose Cotransporter-2 Inhibitors and Major Adverse Cardiovascular Outcomes: A SMART-C Collaborative Meta-Analysis. Circulation. Published 7 April 2024. doi:10.1161/circulationaha.124.069568
Summarised from the published abstract; every number is checked against it