SGLT2 inhibitors improve cardiovascular, hepatic outcomes in MASLD patients

In addition to improving glycaemic control, the use of SGLT2 inhibitors also appears to reduce mortality, hospitalization, cardiovascular events, and liver complications in patients with metabolic dysfunction-associated steatotic liver disease (MASLD), according to a study.

This retrospective cohort study used the TriNetX Network and included a total of 1,280,057 adults with MASLD without prior alcohol-associated liver disease between 2014 and 2022. The investigators stratified patients by SGLT2 inhibitor use and performed propensity score matching (PSM) to balance baseline characteristics between cohorts.

Finally, Cox proportional hazard models were used to calculate hazard ratios (HRs) with 95 percent confidence intervals (CIs).

After PSM, each cohort included 69,970 patients with MASLD. The mean follow-up was 3.70 years for SGLT2 inhibitor users and 4.14 years for nonusers.

SGLT2 inhibitor users had lower all-cause mortality (HR, 0.600, 95 percent CI, 0.580‒0.621) and hospitalization (HR, 0.788, 95 percent CI, 0.777‒0.800).

Treatment with SGLT2 inhibitors also provided several cardiovascular benefits, including reduced risks of acute heart failure exacerbation (HR, 0.872, 95 percent CI, 0.849‒0.896), acute myocardial infarction (HR, 0.916, 95 percent CI, 0.882‒0.952), cerebral infarction (HR, 0.954, 95 percent CI, 0.916‒0.994), and cardiac arrest (HR, 0.661, 95 percent CI, 0.609‒0.718).

Furthermore, SGLT2 inhibitor users had lower risks of acute liver failure (HR, 0.704, 95 percent CI, 0.643‒0.770) and cirrhosis (HR, 0.898, 95 percent CI, 0.861‒0.936).

In safety analysis, SGLT2 inhibitor use resulted in a reduced incidence of acute kidney injury (HR, 0.797, 95 percent CI, 0.779‒0.816), with no significant difference for hypoglycaemia (HR, 0.963, 95 percent CI, 0.914‒1.014).