Right Heart, Right Drug: Sodium-Glucose Co-Transporter 2 Inhibitors in Pulmonary Hypertension: Reduced Mortality and Heart Failure Outcomes In a Large Propensity-Matched Cohort
Abstract Body: Background: Pulmonary hypertension (PH) is associated with high morbidity and mortality, often complicated by right heart failure and other adverse cardiovascular and renal outcomes. Sodium-glucose co-transporter 2 inhibitors (SGLT2i), initially approved for type 2 diabetes, have demonstrated cardiorenal protective effects in various populations. However, their impact in patients with PH remains underexplored.
Methods: We conducted a retrospective cohort study using the TriNetX database (2016–present) to evaluate clinical outcomes in patients with PH, comparing those treated with SGLT2i to those not receiving this therapy. The primary outcomes assessed included all-cause mortality, acute and acute-on-chronic right heart failure (RHF) exacerbations, acute kidney injury (AKI), arrhythmias, and all-cause emergency room (ER) visits. To minimize confounding, 1:1 propensity score matching was performed based on demographics, comorbidities, and concurrent use of guideline-directed medical therapy.
Results: Among 1,689,187 identified PH patients, 456,261 received SGLT2i therapy. After matching, two balanced cohorts of 425,231 patients each were analyzed. SGLT2i use was associated with significantly improved outcomes. There was a 15.25% absolute risk reduction in all-cause mortality (OR 0.33, 95% CI: -15.41% to -15.09%, P < 0.0001). Additionally, there was a 0.26% risk reduction in acute right heart failure (OR 0.51, 95% CI: -0.29% to -0.23%, P < 0.0001) and a 0.51% reduction in acute on chronic right heart failure (OR 0.56, 95% CI: -0.55% to -0.47%, P < 0.0001). Furthermore, the SGLT2i group experienced an 11.12% reduction in acute kidney injury (OR 0.63, 95% CI: -11.33% to -10.91%, P < 0.0001), a 6.00% lower incidence of arrhythmias (OR 0.72, 95% CI: -6.25% to -5.88%, P < 0.0001), and a 5.55% decrease in all-cause emergency room visits (OR 0.78, 95% CI: -5.75% to -5.35%, P < 0.0001).
Conclusion: In this large, real-world analysis, SGLT2i therapy in patients with pulmonary hypertension was associated with significantly lower all-cause mortality and reduced risks of right heart failure exacerbations, AKI, arrhythmias, and emergency room visits. These findings support a potential role for SGLT2i in the management of PH and highlight the need for prospective studies to confirm these benefits.
Salih, Rayan
( Northeast Georgie Medical Center
, Flowery branch
, Georgia
, United States
)
Ahmed, Sana
( Northeast Georgie Medical Center
, Flowery branch
, Georgia
, United States
)
Bhushan, Sheena
( Liver Institute Northwest
, Seattle
, Washington
, United States
)
Mahmood, Riaz
( Georgia Heart Institute
, Gainesville
, Georgia
, United States
)
Umana, Idopise
( Northeast Georgie Medical Center
, Flowery branch
, Georgia
, United States
)
Egolum, Ugochukwu
( Georgia Heart Institute
, Gainesville
, Georgia
, United States
)
Author Disclosures:
Rayan Salih:DO NOT have relevant financial relationships
| Sana Ahmed:No Answer
| Sheena Bhushan:No Answer
| Riaz Mahmood:No Answer
| Idopise Umana:DO NOT have relevant financial relationships
| Ugochukwu Egolum:No Answer
