Clinical Scorecard: Effects of Sodium-Glucose Cotransporter-2 Inhibitors on Heart Failure Outcomes in Patients with Cancer: A Systematic Review and Meta-Analysis

At a Glance

Key Highlights

• SGLT2 inhibitors reduce heart failure hospitalizations by 51% and new heart failure diagnoses by 71% in cancer patients and survivors.
• Breast cancer patients receiving anthracycline chemotherapy experience a 99% reduction in heart failure hospitalization risk with SGLT2 inhibitor use.
• SGLT2 inhibitors offer cardioprotective benefits beyond glucose lowering, potentially mitigating cancer therapy-related cardiac dysfunction.

Guideline-Based Recommendations

Diagnosis

• Monitor for heart failure development in cancer patients receiving cardiotoxic chemotherapy, especially anthracyclines.

Management

• Consider initiation of SGLT2 inhibitors to reduce heart failure risk in cancer patients and survivors, particularly those on anthracycline-based regimens.
• Balance cardioprotective therapy with maintaining effective cancer treatment to avoid compromising oncologic outcomes.

Monitoring & Follow-up

• Regular cardiovascular assessment including left ventricular function during and after cancer therapy.
• Monitor for heart failure symptoms and hospitalizations in patients treated with cardiotoxic agents.

Risks

• Potential cardiotoxicity from chemotherapy agents such as anthracyclines, cyclophosphamides, trastuzumab, and tyrosine kinase inhibitors.
• Need for further prospective trials to confirm safety and efficacy of SGLT2 inhibitors in this population.

Patient & Prescribing Data

88,273 cancer patients and survivors across 13 studies, including breast cancer patients on anthracycline chemotherapy

SGLT2 inhibitors significantly reduce heart failure hospitalizations and new diagnoses, with pronounced benefits in anthracycline-treated breast cancer patients.

Clinical Best Practices

• Integrate SGLT2 inhibitors as a cardioprotective strategy in cancer patients at high risk for heart failure, especially those receiving anthracyclines.
• Maintain multidisciplinary collaboration between oncology and cardiology teams to optimize patient outcomes.
• Conduct prospective clinical trials to establish definitive guidelines for SGLT2 inhibitor use in cardio-oncology.

References

• Editorial comment on SGLT2 inhibitors in cancer patients