Impact of sodium–glucose cotransporter-2 inhibitors on heart failure outcomes in cancer patients and survivors: a systematic review and meta-analysis

Aims Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are recognized for their cardiovascular benefits. This systematic review and meta-analysis evaluated the impact of SGLT2i on heart failure (HF) outcomes in cancer patients and survivors, focusing on HF hospitalization and new HF diagnoses. Methods and results A comprehensive search of PubMed, MEDLINE, and Embase via Ovid, and the Cochrane Library was conducted up to 5 June 2024, focusing on studies involving cancer patients and survivors treated with SGLT2i. The search criterion used was [(SGLT2) OR (Sodium glucose cotransporter 2 inhibitors) OR (canagliflozin) OR (dapagliflozin) OR (empagliflozin) OR (ertugliflozin) AND (cancer)]. The primary outcomes assessed were HF hospitalization and new HF diagnoses. The search yielded 1880 studies, from which 13 studies encompassing 88 273 patients were included. SGLT2i use reduced HF hospitalizations by 51% (RR 0.49, 95% CI 0.36-0.66, I-2 = 28%, P < 0.01) and new HF diagnoses by 71% (RR 0.29, 95% CI 0.10-0.87, I-2 = 71%). Multi-variate meta-regression analysis suggested that among breast cancer populations, studies with >= 50% of patients on anthracyclines exhibited a 99% reduction in HF hospitalization risk compared with similar studies that included <50% of patients on anthracyclines (RR 0.0085, 95% CI: 0.0001-0.2645, P = 0.0081). Conclusion SGLT2i significantly lower the risk of HF hospitalization and new HF diagnoses among cancer patients and survivors, with particularly pronounced benefits in breast cancer patients receiving anthracycline-based chemotherapy. These findings support the need for prospective trials to further investigate the integration of SGLT2i into cancer patient management to enhance cardiovascular outcomes. Lay summary This review of 13 studies, involving 88 273 cancer patients and survivors, suggests that a type of diabetes medication called SGLT2 inhibitors may help protect the heart during and after cancer treatment. These medications appear to lower the risk of heart failure (HF) and reduce hospital visits related to HF. The benefits are particularly promising for breast cancer patients receiving a common chemotherapy type called anthracycline chemotherapy, which can affect heart health. center dot Hospital admissions for HF appeared to drop by half overall, with especially encouraging results in breast cancer patients on anthracycline chemotherapy. center dot The number of new HF cases appeared to fall by more than two-thirds, suggesting these pills might help protect the heart during and after cancer treatment, though more research is needed to confirm these findings.