Racial and regional differences in efficacy of sodium-glucose cotransporter 2 inhibitors on cardiorenal outcomes: a systematic review and meta-analysis
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.
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Data from the U.S. Military Health System reveal continued racial differences in utilization of GLP-1 receptor agonists and SGLT2 inhibitors.
“Data from the U.S. Military Health System, an environment with relatively uniform access, also reveal continued racial differences in utilization, reinforcing the influence of structural and behavioral determinants of care [30,31].”
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- Authors
- Kani, R., Miyamoto, Y., Saito, T., Watanabe, A., Matsubara, K., Ejiri, K., Iwagami, M., Slipczuk, L., Hosseini, K., Fujisaki, T., Takagi, H., Yaku, H., Aikawa, T., & Kuno, T.
- Affiliations
- Kameda Medical Center (JP)
- The University of Tokyo (JP)
- Edogawa Hospital (JP)
- Icahn School of Medicine at Mount Sinai (US)
- Okayama University (JP)
- University of Tsukuba (JP)
- Albert Einstein College of Medicine (US)
- Cardiovascular Diseases Research Institute (IR)
- National Cerebral and Cardiovascular Center (JP)
- Shizuoka Medical Center (JP)
- Northwestern University (US)
- Juntendo University (JP)
- Corresponding author
- Kuno, Toshiki
- ORCID
- Venue
- International Journal of Cardiology
- Publisher
- Elsevier BV
- Published
- 2025-05
- Volume
- 426
- Pages
- 133079
- ISSN
- 0167-5273 (ISSN-L)
- OpenAlex
- W4407731367
- Cited by
- 10
- References
- 63
- Citations by year
- 2026: 6 · 2025: 4
- FWCI
- 1.35
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- International Journal of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Keywords
- SGLT2 inhibitors, cardiorenal outcomes, racial and ethnic differences, regional variation, heart failure hospitalization, cardiovascular mortality, major adverse cardiac events, all-cause mortality, Black patients, Asian patients, health care disparities, clinical trial representation
- MeSH terms
- Sodium-Glucose Transporter 2 Inhibitors, Diabetes Mellitus, Type 2, Heart Failure, Humans, Randomized Controlled Trials as Topic, Treatment Outcome, Racial Groups
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