# SGLT2-remmers tonen geen overlevingsvoordeel bij pulmonale hypertensie — cohortstudie

*geplaatst 2026-11-07 · Hartfalen · Mayo Clinic proceedings. Innovations, quality & outcomes · doi 10.1016/j.mayocpiqo.2026.100765 · https://hartvaat.nl/2026/12/01/sglt2-remmers-tonen-geen-overlevingsvoordeel-bij-pulmonale-hypertensie-cohortstu/*

In een retrospectief, single-center cohort van 366 patiënten met WHO-groep 1 pulmonale arteriële hypertensie (PAH) werd het effect van SGLT2-remmers onderzocht. Hoewel de vaste-expositie-analyse een lagere sterfte suggereerde (HR 0,53; p=0,018), verdween dit effect in de tijd-variabele analyse (HR 0,74; p=0,57). De bevindingen benadrukken dat observatieonderzoek naar SGLT2-remmers bij PAH gevoelig is voor methodologische keuzes en onderstrepen de noodzaak van gerandomiseerde trials voordat klinische toepassing kan worden overwogen.

## English: Sodium-Glucose Cotransporter-2 Inhibitors in World Health Organization Group 1 Pulmonary Arterial Hypertension: A REVEAL Lite 2-Matched Cohort With Time-Varying Exposure Analysis.

In a retrospective, single-center cohort of 366 patients with WHO group 1 pulmonary arterial hypertension (PAH), researchers evaluated the association between SGLT2 inhibitors and clinical outcomes. While fixed-exposure analysis suggested a mortality benefit (HR 0.53; p=0.018), this association disappeared in time-varying analysis (HR 0.74; p=0.57). The findings highlight the sensitivity of observational PAH data to exposure classification and underscore the need for prospective randomized trials before SGLT2 inhibitors can be considered for this population.

## Abstract (original, from the publication)

Sodium-glucose cotransporter-2 inhibitors (SGLT2i) improve outcomes across several cardiometabolic conditions, but their role in World Health Organization group 1 pulmonary arterial hypertension (PAH) remains uncertain. We conducted a retrospective, single-center cohort study of adults with group 1 PAH. Patients prescribed SGLT2i were compared with patients without exposure. Propensity-score matching was performed 1:2 using age, sex, baseline REVEAL Lite 2 risk category, diabetes mellitus, and statin use. The primary outcome was all-cause mortality, and the secondary outcome was major adverse cardiovascular events. Associations were evaluated using fixed-exposure and start-stop time-varying Cox models. The matched cohort included 366 patients: 122 (33%) receiving SGLT2i and 244 (67%) controls. Most patients were classified as high risk by REVEAL Lite 2 (106 SGLT2i recipients (87%) and 215 controls (88%), respectively). In the fixed-exposure analysis, SGLT2i use was associated with lower mortality (hazard ratio [HR], 0.53; 95% CI, 0.31-0.91; P=.018), without a significant difference in major adverse cardiovascular events (HR, 1.23; 95% CI, 0.93-1.63; P=.14). In the time-varying analysis, SGLT2i exposure was not significantly associated with mortality (HR, 0.74; 95% CI, 0.26-2.11; P=.57). The apparent survival association was attenuated after accounting for treatment timing, demonstrating the sensitivity of observational PAH estimates to exposure classification and supporting prospective randomized trials.

Auteurs: Abdelrahman Hafez, Amal Youssef, Mohamed Nour, Juan M Farina, Kamal Awad, Milagros Pereyra Pietri, Isabel G Scalia, Fatmaelzahraa Abdelfattah, Mahshad Razaghi, Laurève Chollet, Sherif Ahmed, Ramzi Ibrahim, Nikita Rafie, Robert L Scott, Chadi Ayoub, Reza Arsanjani

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Bron: Mayo Clinic proceedings. Innovations, quality & outcomes, https://doi.org/10.1016/j.mayocpiqo.2026.100765. Bijgewerkt 2026-11-01T01:51:50Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.