Heart failure & cardiomyopathies
The Cardiovascular Effects of SGLT2 Inhibitors, Renin-angiotensin System (RAS) Inhibitors, and Angiotensin Receptor Neprilysin (ARN) Inhibitors in Heart Failure
Authors' conclusion
Among these drugs, ARNI showed the greatest ability to lower the incidence of CV death or HHF and SGLT2i exerted the least renal injury in patients with HFrEF. In patients with HFpEF, SGLT2i was associated with a reduction in the risk of CV death or HHF.
Study context
- Population
- Patients with Heart Failure with Reduced Ejection Fraction (HFrEF) or Heart Failure with Preserved Ejection Fraction (HFpEF)
- Participants
- 61,489 patients17 RCTs
- Comparison
- SGLT2 inhibitor (SGLT2i) vs RAS inhibitor (RASi) vs ARN inhibitor (ARNI) vs placebo, by HF type
- Outcome
- Composite of:
- CV death
- Hospitalization for HF (HHF)
Methodological detailsLiterature search from inception to 19 November 2022
- Literature search from inception to 19 November 2022
Pooled result
As reported in the abstract
CV death or HHF
Relative risk (95% CI)
ARNIvs PlaceboHFrEF
0.83(0.77–0.89)
SGLT2ivs PlaceboHFpEF
0.82(0.74–0.92)
RASivs SGLT2iHFpEF; direction as printed (SGLT2i vs RASi)
1.16(1.02–1.31)
Further pooled results
Cardiovascular (CV) death or hospitalization for heart failure (HHF) alone (HFrEF)
- Similar trends as for the composite
CV death (HFpEF)
- None of the three drugs showed benefit
HHF (HFpEF)
- SGLT2i and ARNI beneficial; SGLT2i superior to ARNI
Safety
Discontinuation
- No differences vs placebo or each other in HFrEF or HFpEF
Renal injury
- SGLT2i least renal injury in HFrEF; no differences in HFpEF
Original publication
The Cardiovascular Effects of SGLT2 Inhibitors, RAS Inhibitors, and ARN Inhibitors in Heart Failure. ESC Heart Fail. Published 1 February 2023. doi:10.
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