Abstract:
:Sodium-glucose cotransporter 2 inhibitor (SGLT2i) use is associated with improved cardiovascular and kidney outcomes. However, the magnitude and potential heterogeneity of effect across patients with varying types of cardiometabolic and kidney disease is unclear. To examine the effect of SGLT2i on cardiovascular and kidney outcomes among patients with type 2 diabetes mellitus (T2DM), and independent of T2DM status, among patients with heart failure (HF), and chronic kidney disease. METHOD:Medline, Embase, Cochrane library and scientific conferences were searched from inception till September 24, 2020 for randomized controlled trials comparing cardiovascular and kidney outcomes between SGLT2i and placebo. Random effects hazard ratios (HR) with 95% confidence intervals (CIs) were calculated. RESULTS:Eight trials with a combined 59,747 patients were included. In the overall population, SGLT2i reduced the risk of all-cause mortality (HR 0.84; 95% CI [0.78-0.91]), cardiovascular mortality (HR 0.84; 95% CI [0.76-0.93]) hospitalization for HF (HR 0.69; 95% CI [0.64-0.74]), myocardial infarction (HR 0.91; 95% CI [0.84-0.99]), and composite kidney outcome (HR 0.62; 95% CI [0.56-0.70]). There was no significant effect on the risk of stroke (HR 0.98; 95% CI [0.86-1.11]). Results were consistent across subgroups stratified by diabetes and HF status. SGLT2i use was not associated with a greater risk of hypoglycemia (OR 0.92; 95% CI [0.84-1.01]) or amputation (OR 1.25; 95% CI [0.97-1.62]). There were 64 diabetic ketoacidosis events with SGLT2i use and 18 with placebo (OR 2.86; 95% CI [1.39-5.86]). CONCLUSIONS:In patients with cardiometabolic and kidney disease, SGLT2i improved cardiovascular and kidney outcomes, regardless of T2DM, HF, and/or CKD status. The magnitude of risk reduction was largest for hospitalization for HF and progression of kidney disease, more modest for mortality and MI and absent for stroke.
journal_name
Am Heart Jjournal_title
American heart journalauthors
Salah HM,Al'Aref SJ,Khan MS,Al-Hawwas M,Vallurupalli S,Mehta JL,Mounsey JP,Greene SJ,McGuire DK,Lopes RD,Fudim Mdoi
10.1016/j.ahj.2020.10.064subject
Has Abstractpub_date
2021-02-01 00:00:00pages
10-22eissn
0002-8703issn
1097-6744pii
S0002-8703(20)30350-1journal_volume
232pub_type
杂志文章,评审abstract::Although Q wave and non-Q wave MI are often referred to as "transmural" and "nontransmural," there is no anatomic evidence to justify this distinction. Nevertheless, a distinction is important, because the two entities have a different prognosis. At the present time, between 25% and 35% of MIs are non-Q wave. They are...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/0002-8703(89)90629-7
更新日期:1989-04-01 00:00:00
abstract::In a double-blind, randomized crossover study of 12 patients suffering from chronic bronchitis, the comparative influence of equipotent doses of pindolol (5 mg) and metoprolol (100 mg) on the bronchodilatory potential of inhaled fenoterol (0.4 mg), a beta 2-agonist, was investigated by means of body plethysmography. N...
journal_title:American heart journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/0002-8703(82)90138-7
更新日期:1982-08-01 00:00:00
abstract:BACKGROUND:Even mild depressive symptoms during hospitalization are an independent risk factor for mortality after acute coronary syndromes (ACS). The mortality risk is highest for patients whose depressive symptoms persist after ACS. Low adherence to medications that reduce the risk of subsequent cardiac events may be...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2006.05.014
更新日期:2006-11-01 00:00:00
abstract::The purpose of this study was to evaluate feasibility, safety, and efficacy of implantation of unsheathed Palmaz-Schatz coronary stents via the radial artery. Anticoagulation after coronary stenting has the hazard of vascular complications if large-bore guiding catheters are introduced via the femoral artery. Such com...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(94)90023-x
更新日期:1994-07-01 00:00:00
abstract:BACKGROUND:The speed of reperfusion (door-to-balloon [D2B] time) is a well established performance metric for patients with ST-elevation myocardial infarction. Although preferably D2B times should be journal_title:American heart journal pub_type: 杂志文章 doi:10.1016/j.ahj.2008.01.010 更新日期:2008-06-01 00:00:00
abstract:BACKGROUND:Despite advances in treatment of cardiogenic shock (CS), the incidence of this serious complication of acute ST-elevation myocardial infarction (STEMI) has stayed relatively constant, and rates of mortality, although somewhat improved in recent decades, remain dauntingly high. Although both percutaneous coro...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/j.ahj.2009.10.035
更新日期:2010-01-01 00:00:00
abstract:BACKGROUND:Transcatheter aortic valve replacement (TAVR) is an effective therapeutic option for patients with severe aortic stenosis at high risk for surgery. Identification of causes of death after TAVR may help improve patient selection and outcome. METHODS:We enrolled 874 consecutive patients who underwent TAVR at ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2014.07.023
更新日期:2014-11-01 00:00:00
abstract:BACKGROUND:We evaluate a simple, bedside test that measures 1-minute heart rate variability in deep breathing as a predictor of death after myocardial infarction. METHODS:Bedside heart rate variability was assessed in 185 consecutive patients 5.1 +/- 2.5 days after a first myocardial infarction. Patients were instruct...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(99)70242-5
更新日期:1999-07-01 00:00:00
abstract:BACKGROUND:Recent studies suggest that class III antiarrhythmic agents may have enhanced efficacy in the treatment of ventricular tachycardia. This study describes the first clinical assessment of the new class III agent ibutilide to suppress inducible monomorphic ventricular tachycardia (VT) in human beings. METHODS ...
journal_title:American heart journal
pub_type: 临床试验,杂志文章,多中心研究
doi:10.1016/s0002-8703(98)70071-7
更新日期:1998-06-01 00:00:00
abstract:BACKGROUND:Previous studies have suggested that thrombolysis is used less often in blacks than in whites. However, whether the greater prevalence of contraindications or less specific electrocardiographic manifestations of myocardial infarction (MI) account for this difference is unclear. METHODS AND RESULTS:We studie...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1067/mhj.2000.107173
更新日期:2000-08-01 00:00:00
abstract::Magnetic resonance imaging (MRI) produces high-resolution images of great-vessel anatomy in pediatric patients. In this study seven patients, aged 6 to 27 months were evaluated by using gated MRI and two-dimensional echocardiography 4 to 26 months after arterial switch operation for D-transposition of the great arteri...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(94)90486-3
更新日期:1994-08-01 00:00:00
abstract:BACKGROUND:Fractional flow reserve (FFR) has become a gold standard in physiological assessment of coronary artery stenosis. An FFR < 0.75 is considered as a reliable physiological parameter indicating functionally significant lesion. Lesion length (LL) may affect the translesional hemodynamics. However, the effect of ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2004.09.007
更新日期:2005-08-01 00:00:00
abstract::Ambulatory ECG recordings are routinely used to identify patients at increased risk of sudden cardiac death and to monitor changes in ventricular arrhythmias during antiarrhythmic drug therapy. The arrhythmia frequency established during the initial baseline has previously been reported to change during a second place...
journal_title:American heart journal
pub_type: 临床试验,杂志文章
doi:10.1016/0002-8703(88)90139-1
更新日期:1988-10-01 00:00:00
abstract::An experimental canine model of pericardial effusion was designed to validate previous clinical nuclear magnetic resonance imaging (NMR) studies. Saline (n = 7), serum (n = 4), blood (10% hematocrit [n = 5]; 20% hematocrit [n = 5]), and lipid (n = 4) effusions were chosen to resemble: (1) transudative/exudative, (2) n...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(91)90678-b
更新日期:1991-04-01 00:00:00
abstract:BACKGROUND:Selenium is a central determinant of antioxidative glutathione peroxidase 1 (GPx-1) expression and activity. The relevance of selenium supplementation on GPx-1 in coronary artery disease (CAD) needs to be established. We assessed the effect of selenium supplementation on GPx-1 in cell culture and on endothel...
journal_title:American heart journal
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.ahj.2008.09.004
更新日期:2008-12-01 00:00:00
abstract:BACKGROUND:Vesnarinone has yielded controversial results on morbidity in patients with congestive heart failure. We tested the hypothesis that vesnarinone may have a beneficial effect on cardiac remodeling and function. METHODS:Thirty-four patients with left ventricular ejection fraction (LVEF) <30% (17 treated with v...
journal_title:American heart journal
pub_type: 临床试验,杂志文章
doi:10.1016/s0002-8703(98)70120-6
更新日期:1998-11-01 00:00:00
abstract:BACKGROUND:The long-term effects of smoking and smoking cessation on markers of cardiovascular disease (CVD) prognosis obtained during treadmill stress testing (TST) are unknown. The purpose of this study was to evaluate the long-term effects of smoking cessation and continued smoking on TST parameters that predict CVD...
journal_title:American heart journal
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.ahj.2011.06.023
更新日期:2012-01-01 00:00:00
abstract::Intracoronary stents may potentially alleviate some of the problems associated with coronary angioplasty. Since the anatomy and physiology of swine coronary arteries closely resemble those of humans, the response to implantation of the Glanturco-Roubin, balloon-expandable, flexible stent was studied in this model. Add...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(91)90506-d
更新日期:1991-09-01 00:00:00
abstract:BACKGROUND:Elevated resting heart rate (RHR) is known to be associated with reduced survival but inconsistencies remain, including lack of significance in most studies of healthy women, lack of independence from systolic blood pressure (SBP) in some, and the suggestion that RHR is merely functioning as a marker of phys...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2009.12.029
更新日期:2010-04-01 00:00:00
abstract::Blood platelets play essential roles in normal coagulation and in coronary atherosclerotic disease and its complications. Various antiplatelet therapies, including aspirin, ticlopidine, and dipyridamole, have been developed for use in patients with known coronary artery artery disease to prevent ischemic complications...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/0002-8703(95)90091-8
更新日期:1995-10-01 00:00:00
abstract::Patients with diabetes were compared with nondiabetic control subjects, with respect to the prevalence of silent myocardial ischemia, by means of treadmill exercise testing and coronary angiography. Results of treadmill exercise testing showed ischemic ST depression in 41 of the 132 diabetic patients (mean age 61 +/- ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(92)90745-h
更新日期:1992-01-01 00:00:00
abstract:BACKGROUND:Cardiac resynchronization therapy (CRT) is currently indicated in patients with moderate to severe heart failure, a wide QRS complex and significant left ventricular dysfunction despite optimal medical therapy. Adoption of these criteria for CRT results in a favorable response in only two thirds of candidate...
journal_title:American heart journal
pub_type: 杂志文章,多中心研究
doi:10.1016/j.ahj.2004.12.013
更新日期:2005-04-01 00:00:00
abstract::Currently available antiplatelet agents are limited in the scope and magnitude of platelet inhibition. Orally active platelet glycoprotein IIb/IIIa antagonists are currently in clinical testing. These agents may extend platelet inhibition and clinical benefit from parenteral glycoprotein IIb/IIIa antagonists. The most...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1053/hj.1999.v138.99080
更新日期:1999-07-01 00:00:00
abstract:BACKGROUND:Studies have shown that cigarette smokers constitute a substantial proportion of patients with acute coronary syndromes (ACS) and have platelet-rich coronary thrombi. We characterized the influence of smoking status on outcome of patients with ACS without persistent ST-segment elevation and tested the hypoth...
journal_title:American heart journal
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1016/s0002-8703(00)90089-9
更新日期:2000-03-01 00:00:00
abstract:BACKGROUND:A previous randomized controlled trial evaluating the use of spironolactone in heart failure patients reported a low risk of hyperkalemia (2%) and renal insufficiency (0%). Because treatments for heart failure have changed since the benefits of spironolactone were reported, the prevalence of these complicati...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2004.10.005
更新日期:2004-12-01 00:00:00
abstract::To determine which method of surgical therapy might be optimal for patients with anomalous left coronary artery from the pulmonary artery (ALCAPA), a follow-up study was performed. Twenty-nine teenagers and adults who had ALCAPA diagnosed during life at age 13 years or older were identified mainly by literature search...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(79)90248-5
更新日期:1979-10-01 00:00:00
abstract:BACKGROUND:Apparent treatment-resistant hypertension (aTRH) is associated with an increased risk of adverse cardiovascular outcomes. We studied the frequency and intensity of care for aTRH among participants aged 65 years and older in the US-based REGARDS study linked with Medicare claims. METHODS:Blood pressure (BP) ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2017.01.008
更新日期:2017-04-01 00:00:00
abstract::Antiarrhythmic drugs are often more effective in suppressing ventricular tachycardias than are background premature extrasystoles. The mechanism of action of these agents was examined by studies on the effects of lidocaine and quinidine on post-repolarization refractoriness of both basic and premature action potential...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(89)90222-6
更新日期:1989-11-01 00:00:00
abstract::A counterimmunoelectrophoresis technique for detection of serum myoglobin (Mb) was improved using non-ionic polymer dextran. Precipitin lines were graded according to their strength, which was ascertained by radioimmunoassay data. By this method, serum Mb in concentrations of 500 ng./ml. before stain and of 200 ng./ml...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(78)90084-4
更新日期:1978-08-01 00:00:00
abstract::Current evidence suggests that the pathogenesis of atrial fibrillation (AF) is multifactorial. The observation that AF, once present, alters the electrophysiologic properties of the atrial myocardium causing self-perpetuation of the arrhythmia raised the importance of electrical remodeling in its pathogenesis. Althoug...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/j.ahj.2008.10.009
更新日期:2009-02-01 00:00:00