Frontiers in cardiovascular medicine · 2026
Effectiveness of low-dose SGLT2 inhibitors in diabetic patients with heart failure: a nationwide cohort study.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Kim Minkwan, Heo Seok-Jae, Bae SungA, Jung In Hyun, Cho Deok-Kyu
Аннотация
BACKGROUND AND OBJECTIVES: SGLT2 inhibitors (SGLT2i) are a cornerstone of guideline-directed therapy for heart failure (HF). However, the optimal dose for HF remains unclear, as no phase II trials have evaluated dose-response in this population. This study aimed to evaluate whether low-dose (5 mg) of SGLT2i provide comparable efficacy and safety compared with the standard 10 mg dose and to non-users.
METHODS: This nationwide retrospective cohort study utilized Korean National Health Insurance Service claims data (2013-2018), including 551,760 patients with HF and diabetes, of whom 55,694 were SGLT2i users. After exclusions, propensity-score matching was performed in a 5:5:1 ratio (non-users:10 mg:5 mg). The composite primary outcome was cardiac death, HF hospitalization, or urgent HF-related emergency department (ED) visit. Safety outcomes included ketoacidosis, acute kidney injury (AKI), urinary tract infection, and fractures.
RESULTS: In the matched cohort (2,637 on 5 mg; 13,185 on 10 mg; 13,185 non-users), the 5 mg group was associated with lower risk of the primary outcome (HR: 0.73, 95% CI: 0.66-0.81; P < 0.001) and all-cause death (HR 0.85, 95% CI 0.74-0.97; P = 0.019) compared with 10 mg, with similar safety profiles. Significant interactions were observed: the relative effect of 5 mg vs. 10 mg differed by sex and body weight for urgent ED visits, and by BMI for AKI. Sensitivity analyses across multiple time points showed consistent results, with the 5 mg group associated with comparable or lower risk compared with the 10 mg group.
CONCLUSIONS: In patients with diabetes and HF, 5 mg daily SGLT2i was associated with a comparable risk to 10 mg, warranting randomized dose-finding trials.
METHODS: This nationwide retrospective cohort study utilized Korean National Health Insurance Service claims data (2013-2018), including 551,760 patients with HF and diabetes, of whom 55,694 were SGLT2i users. After exclusions, propensity-score matching was performed in a 5:5:1 ratio (non-users:10 mg:5 mg). The composite primary outcome was cardiac death, HF hospitalization, or urgent HF-related emergency department (ED) visit. Safety outcomes included ketoacidosis, acute kidney injury (AKI), urinary tract infection, and fractures.
RESULTS: In the matched cohort (2,637 on 5 mg; 13,185 on 10 mg; 13,185 non-users), the 5 mg group was associated with lower risk of the primary outcome (HR: 0.73, 95% CI: 0.66-0.81; P < 0.001) and all-cause death (HR 0.85, 95% CI 0.74-0.97; P = 0.019) compared with 10 mg, with similar safety profiles. Significant interactions were observed: the relative effect of 5 mg vs. 10 mg differed by sex and body weight for urgent ED visits, and by BMI for AKI. Sensitivity analyses across multiple time points showed consistent results, with the 5 mg group associated with comparable or lower risk compared with the 10 mg group.
CONCLUSIONS: In patients with diabetes and HF, 5 mg daily SGLT2i was associated with a comparable risk to 10 mg, warranting randomized dose-finding trials.