Effect of Sodium-glucose Cotransporter 2 Inhibitors with Cardiovascular Adverse Events and Nephropathy Progression in Metformin Treated Diabetic Patients with Heart Failure

SU Yongqin

doi:10.12102/j.issn.1672-1349.2025.09.018

Abstract：Objective: To investigate the relationship between sodium-glucose cotransporter 2 inhibitors (SGLT2i) and adverse cardiovascular events and renal disease progression in patients with diabetes and heart failure who are treated with metformin. Methods: Clinical data of 331 patients with diabetes and heart failure who received oral metformin treatment at our hospital from March 2020 to March 2023 were collected. The patients were divided into SGLT2i group (105 cases) and non-SGLT2i group (226 cases) based on whether they used SGLT2i. Demographic characteristics, hospitalization records, prescription information, laboratory data, left ventricular ejection fraction (LVEF), date and cause of death were collected and analyzed. Estimated glomerular filtration rate (eGFR) was calculated. When patients did not die due to heart failure, the cause of death was reviewed and the occurrence of adverse cardiovascular events was counted. The progression of renal disease was followed up. Results: Compared with the non-SGLT2i group, the SGLT2i group had a significantly lower incidence of adverse cardiovascular events [HR=0.47, 95% CI (0.28, 0.77), P=0.01] and a significantly lower progression rate of renal disease [HR=0.27, 95% CI (0.12, 0.61), P=0.02]. The SGLT2i group also had a significantly lower heart failure hospitalization rate [HR=0.46, 95% CI (0.25, 0.83), P=0.03] and a significantly lower incidence of acute kidney injury [HR=0.24, 95% CI (0.09, 0.64), P=0.04]. The SGLT2i group showed a trend toward lower cardiovascular mortality [HR=0.69, 95% CI (0.18, 0.97), P=0.15] and dialysis incidence [HR=0.35, 95% CI (0.07, 1.68), P=0.33], but the differences were not statistically significant. Logistic regression analysis showed that receiving SGLT2i treatment, age <60 years, eGFR <60 mL/(min·1.73 m²), and metformin use for ≥90 days were independent factors influencing adverse cardiovascular events in patients with diabetes and heart failure. Receiving SGLT2i treatment, male gender, eGFR <60 mL/(min·1.73 m²), and systolic blood pressure ≥140 mmHg were independent factors influencing renal disease progression. Conclusion: In patients with diabetes and heart failure, those who received SGLT2i treatment had a lower risk of adverse cardiovascular and renal events compared to those who did not receive SGLT2i treatment.