SGLT2 inhibitors prevent major cardiac and renal events in cardio-nephro-metabolic syndrome

The concept of CKM syndrome was formalised by the American Heart Association (AHA) at its annual congress in 2023. The scientific society defines this syndrome as "a health disorder attributable to the connections between obesity, diabetes, chronic kidney disease, and cardiovascular disease, including heart failure, atrial fibrillation, coronary artery disease, strokes, and peripheral artery disease."

Five stages of this syndrome are identified, ranging from the absence of metabolic risk factors (stage 0) to stage 4 (metabolic syndrome and/or chronic nephropathy, and the presence of clinical cardiovascular disease). SGLT2 inhibitors, in addition to their hypoglycaemic effects, slow the progression of renal insufficiency, have cardioprotective effects, and promote weight loss, remind Tao Liu from the Civil Aviation General Hospital in Beijing and colleagues.

SGLT2 inhibitors have been extensively studied in type 2 diabetics, patients with chronic nephropathy, and those with cardiovascular diseases, but no study has been specifically conducted in stage 4 CKM syndrome, they point out.

They conducted a retrospective observational study including patients diagnosed with stage 4 CKM syndrome hospitalised between March 2021 and September 2023 at the Civil Aviation General Hospital in Beijing. Out of 3,657 patients included, 812 pairs of patients taking and not taking SGLT2 inhibitors, matched on a propensity score, were constituted.

The occurrence of major adverse cardiovascular events (MACE), major adverse renal events (MAKE), and all-cause mortality was evaluated over one year.

The MACE rate was significantly lower in the group using SGLT2 inhibitors (8.5% versus 13.1%), with a significantly reduced hazard ratio of 27.4%. This decrease was mainly driven by a lower risk of cardiovascular death (-12.4%) and rehospitalisation for heart failure (-32.7%).

The MAKE rate was also significantly lower in the SGLT2 inhibitor group (6.5% versus 10.2%), with the hazard ratio reduced by 11.5%, mainly due to the reduction in the risk of renal function deterioration (-19.7%).

The mortality rate was significantly lower in the SGLT2 inhibitor group (0.5% versus 1.8%), with a risk reduction of 11.3%.

These results support the potential cardiovascular and renal benefits of SGLT2 inhibitors in this population, the authors conclude.

(JAHA) 

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