Abstract 4339739: SGLT-2 Inhibitors in the Prevention of Chemotherapy-Induced Cardiotoxicity: A Systematic Review and Meta-Analysis

Background: Chemotherapy is linked to significant cardiotoxicity. While guideline-directed heart failure therapies help mitigate these effects, the role of sodium-glucose cotransporter-2 (SGLT2) inhibitors remains unclear. Objectives: To systematically evaluate cardiovascular outcomes associated with SGLT2 inhibitor use in cancer patients undergoing chemotherapy. Methods: We conducted a meta-analysis of cohort studies comparing cardiovascular outcomes between cancer patients receiving SGLT2 inhibitors and those not receiving SGLT2 inhibitors. We searched PubMed, Embase, and other major databases through August 2024. Primary outcome was all-cause mortality. Secondary outcomes included heart failure hospitalizations and post-chemotherapy left ventricular ejection fraction in both the groups. We used fixed and random effect binomial meta-analysis fit using the Mantel-Haenszel method for each outcome of interest. All analyses were conducted using the ‘meta’ package in R Statistical Software. Results: Eleven cohort studies involving 268,9260 patients were included in the analsyis. SGLT2 inhibitor use was associated with a significantly lower risk of all-cause mortality (OR 0.27, 95% CI 0.25-0.28, P < 0.0001), cardiac events (OR 0.49, 95% CI 0.49–0.53, P= 0.0001), cardiac dysfunction (OR 0.62, 95% CI 0.56-0.69, P < 0.0002) and heart failure hospitalizations (OR 0.67, 95% CI 0.61-0.75, P < 0.0003) compared to non-use. Conclusions: SGLT2 inhibitors offer significant cardioprotective benefits in cancer patients undergoing cardiotoxic chemotherapy, with reducing mortality and composite cardiac events. These findings support the potential of SGLT2 inhibitors as a beneficial therapeutic option for improving cardiovascular outcomes in at-risk populations.