Racial and Regional Differences in Efficacy of Sodium-Glucose Cotransporter 2 Inhibitors on Cardiorenal Outcomes: A Systematic Review and Meta-Analysis Publisher Pubmed



Kani R¹ ; Miyamoto Y² ; Saito T³ ; Watanabe A⁴ ; Matsubara K¹ ; Ejiri K⁵ ; Iwagami M^{6, 7} ; Slipczuk L⁸ ; Hosseini K⁹ ; Fujisaki T^{10, 11} ; Takagi H¹² ; Yaku H¹³ ; Aikawa T¹⁴ ; Kuno T^{8, 15} Show Affiliations
Source: International Journal of Cardiology Published:2025

Abstract

Background: To investigate the efficacy of SGLT2 inhibitors on multiple cardiorenal outcomes across different racial/ethnic groups and regions. Methods: We searched PubMed, Cochrane Library, Web of Science, and Embase databases in April 2024 for a systematic review and meta-analysis. Owing to inconsistencies in the reporting of the racial/ethnic and regional demographics, participants were grouped into three racial groups (Asian, Black, and White) and four regional (Asia, Central/South America, Europe, North America) groups. We compared the efficacy of SGLT2 inhibitors among these racial/ethnic and regional groups by calculating the ratio of hazard ratios (RHR). We evaluated the composite of cardiovascular death or hospitalization for heart failure (HHF), cardiovascular death, HHF, all-cause death, major adverse cardiac events, and cardiorenal composite outcomes. Results: We included 14 randomized placebo-controlled trials with 94,445 participants. Across the three racial/ethnic groups, SGLT2 inhibitors showed comparable efficacy. Compared with White patients, the efficacy of SGLT2 inhibitors on HHF was more pronounced in Black patients (RHR, 0.64; 95 % confidence interval [CI], 0.44–0.94), and a numerically lower risk was associated with Asian patients (RHR, 0.62; 95 % CI, 0.38–1.01). A consistent reduction in cardiovascular events with SGLT2 inhibitors was observed across all regions, while the efficacy of SGLT2 inhibitors on HHF was more pronounced in Asia than in other regions (RHR, 0.52; 95 % CI, 0.33–0.81). Conclusions: SGLT2 inhibitors showed generally consistent efficacy across various racial/ethnic and regional groups, with some differences noted in specific populations. Ensuring adequate representation of diverse populations in clinical trials would be key to addressing healthcare disparities. © 2025 Elsevier B.V.