SGLT2 Inhibitors Reduce Heart Failure Risk in Cancer Patients: Meta-Analysis

Overview

This systematic review and meta-analysis of 13 studies involving 88,273 cancer patients and survivors found that sodium-glucose cotransporter-2 inhibitors (SGLT2i) significantly reduce heart failure (HF) hospitalizations by 51% and new HF diagnoses by 71%. The cardioprotective effects were especially pronounced in breast cancer patients receiving anthracycline chemotherapy.

Background

Cancer treatments, particularly anthracycline chemotherapy, are known to cause cardiotoxicity leading to heart failure, which adversely affects patient outcomes and quality of life. Traditional approaches to mitigate cardiotoxicity include reducing chemotherapy exposure or initiating cardioprotective medications, but these strategies can compromise cancer treatment efficacy. SGLT2 inhibitors, originally developed as glucose-lowering agents, have demonstrated cardiovascular benefits including reduced HF hospitalizations in diverse populations. Their potential role in preventing cancer therapy-related cardiac dysfunction (CTRCD) is of growing clinical interest.

Data Highlights

Key Findings

• SGLT2 inhibitors reduced heart failure hospitalizations by 51% in cancer patients and survivors.
• New heart failure diagnoses were reduced by 71% with SGLT2i use.
• Among breast cancer patients receiving anthracycline chemotherapy, SGLT2i use was associated with a 99% reduction in HF hospitalization risk.
• The cardioprotective benefits of SGLT2i extend beyond glucose lowering, potentially through improved cardiac metabolism and reduced inflammation.
• These findings support the potential integration of SGLT2i into cardio-oncology care to mitigate chemotherapy-induced cardiotoxicity.

Clinical Implications

Clinicians should consider the cardioprotective potential of SGLT2 inhibitors in cancer patients, especially those receiving anthracycline-based chemotherapy, to reduce the risk of heart failure and related hospitalizations. Incorporating SGLT2i therapy may improve cardiovascular outcomes without compromising cancer treatment efficacy. Prospective clinical trials are warranted to establish definitive guidelines for SGLT2i use in this population.

Conclusion

SGLT2 inhibitors significantly reduce heart failure risk and hospitalizations in cancer patients, with pronounced benefits in those treated with anthracyclines. These results highlight the promise of SGLT2i as a cardio-protective strategy in oncology care.

References

1. Cautela and Alexandre 2024 -- SGLT2 inhibitors in cancer patients: a paradigm shift in cardio-oncology?