TY - JOUR
T1 - SGLT2 Inhibitor Use and Risk of Clinical Events in Patients With Cancer Therapy–Related Cardiac Dysfunction
AU - Avula, Vennela
AU - Sharma, Garima
AU - Kosiborod, Mikhail N.
AU - Vaduganathan, Muthiah
AU - Neilan, Tomas G.
AU - Lopez, Teresa
AU - Dent, Susan
AU - Baldassarre, Lauren
AU - Scherrer-Crosbie, Marielle
AU - Barac, Ana
AU - Liu, Jennifer
AU - Deswal, Anita
AU - Khadke, Sumanth
AU - Yang, Eric H.
AU - Ky, Bonnie
AU - Lenihan, Daniel
AU - Nohria, Anju
AU - Dani, Sourbha S.
AU - Ganatra, Sarju
N1 - Publisher Copyright:
© 2024 American College of Cardiology Foundation
PY - 2024/1
Y1 - 2024/1
N2 - Background: Certain antineoplastic therapies are associated with an increased risk of cardiomyopathy and heart failure (HF). Sodium glucose co-transporter 2 (SGLT2) inhibitors improve outcomes in patients with HF. Objectives: This study aims to examine the efficacy of SGLT2 inhibitors in patients with cancer therapy–related cardiac dysfunction (CTRCD) or HF. Methods: The authors conducted a retrospective cohort analysis of deidentified, aggregate patient data from the TriNetX research network. Patients aged ≥18 years with a history of type 2 diabetes mellitus, cancer, and exposure to potentially cardiotoxic antineoplastic therapies, with a subsequent diagnosis of cardiomyopathy or HF between January 1, 2013, and April 30, 2020, were identified. Patients with ischemic heart disease were excluded. Patients receiving guideline-directed medical therapy were divided into 2 groups based on SGLT2 inhibitor use. After propensity score matching, odds ratios (ORs) and Cox proportional HRs were used to compare outcomes over a 2-year follow-up period. Results: The study cohort included 1,280 patients with CTRCD/HF (n = 640 per group; mean age: 67.6 years; 41.6% female; 68% White). Patients on SGLT2 inhibitors in addition to conventional guideline-directed medical therapy had a lower risk of acute HF exacerbation (OR: 0.483 [95% CI: 0.36-0.65]; P < 0.001) and all-cause mortality (OR: 0.296 [95% CI: 0.22-0.40]; P = 0.001). All-cause hospitalizations or emergency department visits (OR: 0.479; 95% CI: 0.383-0.599; P < 0.001), atrial fibrillation/flutter (OR: 0.397 [95% CI: 0.213-0.737]; P = 0.003), acute kidney injury (OR: 0.486 [95% CI: 0.382-0.619]; P < 0.001), and need for renal replacement therapy (OR: 0.398 [95% CI: 0.189-0.839]; P = 0.012) were also less frequent in patients on SGLT2 inhibitors. Conclusions: SGLT2 inhibitor use is associated with improved outcomes in patients with CTRCD/HF.
AB - Background: Certain antineoplastic therapies are associated with an increased risk of cardiomyopathy and heart failure (HF). Sodium glucose co-transporter 2 (SGLT2) inhibitors improve outcomes in patients with HF. Objectives: This study aims to examine the efficacy of SGLT2 inhibitors in patients with cancer therapy–related cardiac dysfunction (CTRCD) or HF. Methods: The authors conducted a retrospective cohort analysis of deidentified, aggregate patient data from the TriNetX research network. Patients aged ≥18 years with a history of type 2 diabetes mellitus, cancer, and exposure to potentially cardiotoxic antineoplastic therapies, with a subsequent diagnosis of cardiomyopathy or HF between January 1, 2013, and April 30, 2020, were identified. Patients with ischemic heart disease were excluded. Patients receiving guideline-directed medical therapy were divided into 2 groups based on SGLT2 inhibitor use. After propensity score matching, odds ratios (ORs) and Cox proportional HRs were used to compare outcomes over a 2-year follow-up period. Results: The study cohort included 1,280 patients with CTRCD/HF (n = 640 per group; mean age: 67.6 years; 41.6% female; 68% White). Patients on SGLT2 inhibitors in addition to conventional guideline-directed medical therapy had a lower risk of acute HF exacerbation (OR: 0.483 [95% CI: 0.36-0.65]; P < 0.001) and all-cause mortality (OR: 0.296 [95% CI: 0.22-0.40]; P = 0.001). All-cause hospitalizations or emergency department visits (OR: 0.479; 95% CI: 0.383-0.599; P < 0.001), atrial fibrillation/flutter (OR: 0.397 [95% CI: 0.213-0.737]; P = 0.003), acute kidney injury (OR: 0.486 [95% CI: 0.382-0.619]; P < 0.001), and need for renal replacement therapy (OR: 0.398 [95% CI: 0.189-0.839]; P = 0.012) were also less frequent in patients on SGLT2 inhibitors. Conclusions: SGLT2 inhibitor use is associated with improved outcomes in patients with CTRCD/HF.
KW - antineoplastic therapy
KW - cardiomyopathy
KW - outcomes
KW - SGLT2 inhibitors
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U2 - 10.1016/j.jchf.2023.08.026
DO - 10.1016/j.jchf.2023.08.026
M3 - Article
C2 - 37897456
AN - SCOPUS:85180334350
SN - 2213-1779
VL - 12
SP - 67
EP - 78
JO - JACC: Heart Failure
JF - JACC: Heart Failure
IS - 1
ER -