Objectives Heart failure with mildly reduced ejection fraction (HFmrEF)  or  heart failure with preserved ejection fraction (HFpEF)  are associated with significant morbidity and mortality, as well as growing health and economic burden. Sodium-glucose co-transporter 2 (SGLT2) inhibitors are very promising for the outcome improvement of patients with HFpEF or HFmrEF. The meta-analysis was performed to investigate the effects of SGLT2 inhibitors in HFpEF or  HFmrEF, by pooling data from all clinically randomized controlled trials (RCTs) available to increase power to testify. Methods Studies were searched in electronic databases from inception to November, 2022. We performed a meta-analysis to estimate the effect of SGLT2 inhibitors on clinical endpoints in patients with HFpEF or HFmrEF, using trial-level data with consistent endpoint definitions. The primary outcome was the composite of heart failure (HF) hospitalization or cardiovascular death. Hazard ratio (HR) was pooled with 95% confidence interval (CI) for dichotomous data. This study was registered with INPLASY 2022110095. Results Six studies involving 15,989 participants were included into the final analysis. Pooled analyses revealed that SGLT2 inhibitors significantly reduced the composite of HF hospitalization or cardiovascular death [HR: 0.79 (0.72–0.85); I2 = 0%; P < 0.00001] and HF hospitalizations [HR: 0.74 (0.67–0.82); I2 = 0%; P < 0.00001]. This finding was seen in both HFmrEF trials [HR: 0.76 (0.67–0.87); I2 = 49%; P < 0.0001] and HFpEF subgroup studies [HR: 0.70 (0.53–0.93); I2 = 0%; P = 0.01]. The incidence of any serious adverse events [OR: 0.89 (0.83–0.96); I2 = 0%; P = 0.002] was significantly lower in the SGLT2 inhibitor arm. No significant differences were observed between the two groups with regard to cardiovascular death and all-cause death. Conclusions This meta-analysis of patients with heart failure of left ventricular ejection fraction (LVEF) > 40% showed that SGLT2 inhibitors significantly reduce the risk of  the composite of cardiovascular death and hospitalization for heart failure, but not cardiovascular death and all-cause death. Nevertheless, given that SGLT2 inhibitors may reduce the risk of hospitalization for heart failure, they should be considered the fundamental treatment for all patients with HFpEF or  HFmrEF.

Losartan has become a hot spot in the treatment of non-alcoholic fatty liver disease (NAFLD) among angiotensin receptor blocker drugs. We sought to conduct a systematic examination and meta-analysis to examine the effects of losartan on patients with NAFLD. We searched for potentially randomized controlled trials in PubMed, Embase, China National Knowledge Infrastructure, Wanfang, and the Cochrane database up to October 09, 2022. We used the Cochrane risk of bias tool to evaluate the study quality. Analysis of subgroups, sensitivity analysis, and publishing bias were explored. The quality of the included studies was moderate to high. Six trials involving 408 patients were included. The meta-analysis demonstrated that aspartate transaminase was significantly affected by losartan therapy (mean difference [MD] = −5.34, 95% confidence interval [CI] [−6.54, −4.13], Z = 8.70, P < 0.01). The meta-analysis subgroup showed that losartan 50 mg once daily could lower the level of alanine aminotransferase (MD = −18.92, 95% CI [−21.18, −16.66], Z = 16.41, P < 0.01). There was no statistically significant difference in serum total cholesterol, triglyceride, low-density lipoprotein, and high-density lipoprotein.

Background The patients with return of spontaneous circulation post cardiac arrest have a mortality rate of up to 30-50%. Hemodynamic support is a key component of out-of-hospital cardiac arrest (OHCA) management and is essential to ensure survival. The meta-analysis was performed to investigate the optimizing blood pressure targets in survivors of OHCA. Methods Studies were searched in electronic databases from January 1, 2015 to January 13, 2023. Results were pooled using random effects model and fixed effects model and are presented as odd ratios (ORs) with 95% confidence intervals (CI). The primary outcome was all-cause death and the secondary outcome were severe bleeding, arrhythmia, renal replacement therapy, cerebral performance category (CPC) score≥3, modified Rankin Scale (mRS) score≥4 and the level of serum norepinephrine, neuron-specific enolase (NSE), troponin T.This study was registered with INPLASY 2022120065. Results Four studies involving 1,327 participants were included. No significant differences of the risk of all-cause death were found between the low-target blood pressure and high-target blood pressure strategy (OR 0.93 [95% CI 0.73–1.17], I²=0%, P=0.55). Meanwhile, the low-target blood pressure therapy had a higher proportion of mRS score≥4 (OR 0.43 [95% CI 0.20–0.94], I²=0%, P=0.03) ≥4 compared with the high-target blood pressure therapy. No significant between-group differences were identified among patients in the level of the serum NSE (SD 0.82 [95% CI -1.50–3.13], I²=28%, P=0.49), troponin T (SD 0.54 [95% CI -0.03–1.12], I²=0%, P=0.07), renal replacement therapy (OR 1.09 [95% CI 0.71–1.69], I²=49%, P=0.69), severe bleeding(OR 1.18 [95% CI 0.85–1.65], I²=0%, P=0.33) and arrhythmia(OR 0.84 [95% CI 0.57–1.24], I²=0%, P=0.38). Conclusions The higher mean arterial pressure (MAP) is not associated with improved outcome when compared to conventional target, but may be associated with worse neurological outcome.