Cardiovascular, limb, and kidney effects of SGLT2 inhibitors in patients with peripheral artery disease: a systematic review and meta-analysis of randomized controlled trial data
Pooled result · HHF or CV deathResult — go to the resultHazard ratio 0.73 95% CI 0.64–0.83Authors' conclusion
SGLT2i-therapy is associated with a reduced risk of composite of cardiovascular and kidney outcomes in patients with PAD, without increasing the risk of amputation. These findings support a potential role of sustained long-term SGLT2i-therapy in this high-risk group.
Study context
- Population
- Patients with peripheral artery disease (PAD); PubMed, Embase and Cochrane Library searched to 20 December 2025
- Participants
- 7,275 patients5 studies
- Comparison
- SGLT2i vs control
- Outcome
- Composite of:
- Hospitalization for HF (HHF)
- CV death
Pooled result
HHF or CV death
Hazard ratio
0.73
95% CI 0.64–0.83
P < 0.001
SGLT2ivs Control
HR 0.73 (95% CI 0.64–0.83); P < 0.001
As reported in the abstract
Further pooled results
Hospitalization for heart failure (HHF)
| HR (95% CI) | P value | ||
|---|---|---|---|
| SGLT2i | 0.63 (0.51–0.77) | P < 0.001 | |
| 0.512Hazard ratio (log scale) |
CV death
| HR (95% CI) | P value | ||
|---|---|---|---|
| SGLT2i | 0.83 (0.69–1.00) | P = 0.045 | |
| 0.512Hazard ratio (log scale) |
Adverse renal outcomes
| HR (95% CI) | P value | ||
|---|---|---|---|
| SGLT2i | 0.74 (0.55–0.98) | P = 0.038 | |
| 0.512Hazard ratio (log scale) |
CV death by SGLT2i treatment duration (exploratory subgroup analysis)
| HR (95% CI) | P value | ||
|---|---|---|---|
| SGLT2iTreatment ≥ 2 years; no clear effect in trials < 2 years · exploratory subgroup analyses | 0.73 (0.60–0.90) | P for interaction = 0.06 | |
| 0.512Hazard ratio (log scale) |
- CV death by SGLT2i treatment duration (exploratory subgroup analysis): no effect modification by PAD status (all Pinteraction >0.10)
All-cause mortality
- No significant reduction in all-cause mortality, HR
- 0.86 (0.69 to 1.08; p = 0.192) (95% CI; p)
MACE
- No significant reduction in MACE, HR
- 0.89 (0.75to 1.06; p = 0.207) (95% CI; p)
Safety
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| AmputationSGLT2ivs Control | 1.17 (0.87–1.56) | P = 0.293 | |
| 0.512Hazard ratio (log scale) |
Original publication
Cardiovascular, limb, and kidney effects of SGLT2 inhibitors in patients with peripheral artery disease: a systematic review and meta-analysis of randomized controlled trial data. Cardiovasc Diabetol. Published 17 May 2026. doi:10.
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