# Effect on cardiovascular outcome of sodium-glucose co-transporter-2 (SGLT2) inhibitors among cancer patients treated with anthracycline: a systematic review and meta-analysis

## TL;DR

This study finds that SGLT2 inhibitors may reduce all-cause mortality in cancer patients treated with anthracyclines, though more research is needed.

## Contribution

The study is the first to meta-analyze the cardiovascular benefits of SGLT2 inhibitors in anthracycline-treated cancer patients.

## Key findings

- SGLT2 inhibitors were associated with significantly lower all-cause mortality in anthracycline-treated cancer patients.
- No significant difference was found in heart failure exacerbation risk between SGLT2 inhibitor users and non-users.
- The study highlights the need for randomized clinical trials to confirm these findings.

## Abstract

Sodium-glucose-co-transporter-2 (SGLT2) inhibitors have shown benefit in reducing cardiovascular disease outcomes in diabetes patients. Anthracycline therapy is associated with a risk of cardiomyopathy. However, the impact of SGLT2 inhibitors in the prevention of cardiomyopathy and heart failure in cancer patients undergoing anthracycline treatment remains unclear. Thus, we conducted a systematic review and meta-analysis to explore the effect of the prevention of cardiovascular outcomes in patients with cancer and diabetes who had received anthracycline therapy.

We systematically reviewed Medline and EMBASE databases from inception to January 2024 for studies focusing on cancer patients with a history of anthracycline therapy. Eligible studies had to report relative risk (RR) with 95% confidence intervals (CIs) for the clinical endpoints of mortality outcomes and the risk of heart failure exacerbation, comparing cohorts with and without SGLT2 inhibitor use.

Our study included four retrospective cohort studies in the meta-analysis (n = 6,708, 24% received SGLT2). There was significantly lower all-cause mortality in the SGLT2 inhibitors group (pooled RR of 0.52, 95% CI 0.35–0.77, I2 64%). However, there were no differences in the risk of heart failure exacerbation (pooled RR of 0.67, 95% CI 0.39–1.14, I2 17%).

Our study found that anthracycline-treated cancer patients using SGLT2 inhibitors experienced lower all-cause mortality compared to the control group. A randomised clinical trial is necessary to further elucidate these findings.