SGLT2 Inhibitor Use Linked to Lower Risk for Heart Failure, Death in Type 2 Diabetes

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There was no association between initiation of SGLT2 inhibitors and other glucose-lowering drugs and the onset of atrial fibrillation.
There was no association between initiation of SGLT2 inhibitors and other glucose-lowering drugs and the onset of atrial fibrillation.

The use of sodium-glucose co-transporter-2 (SGLT2) inhibitors was associated with lower rates of death and heart failure (HF) in patients with and without established cardiovascular disease (CVD), according to findings published in the Journal of the American College of Cardiology.

The observational CVD-REAL (Comparative Effectiveness of Cardiovascular Outcomes in New Users of SGLT-2 Inhibitors; ClinicalTrials.gov Identifier: NCT02993614) study included more than 300,000 adults with type 2 diabetes who were prescribed an SGLT2 inhibitor or other glucose-lowering drugs and matched on the basis of a propensity score for initiation of an SGLT2 inhibitor.

The objective of the study was to determine the association between initiation of SGLT2 inhibitor therapy and HF or death, regardless of CVD history and status.

At baseline, 13% of the cohort were identified to have established CVD. As compared with therapy using other glucose-lowering drugs, the initiation of an SGLT2 inhibitor was associated with lower mortality risk in individuals both with and without a history of CVD (hazard ratio [HR], 0.56 [95% CI, 0.44-0.70] and HR, 0.56 [95% CI, 0.50-0.63], respectively).

Compared with other glucose-lowering drugs, SGLT2 inhibitors were also associated with lower risk for HF for both groups (2.3 vs 3.2 events per 100 patient-years, respectively [HR, 0.72; 95% CI, 0.63-0.82] and 0.1 vs 0.2 events per 100 patient-years, respectively [HR, 0.61; 95% CI, 0.48-0.78]).

The use of SGLT2 inhibitors vs use of other glucose-lowering drugs was associated with lower risk for the composite end point of death or HF in patients with and without CVD (4.0 vs 6.7 events per 100 patient-years, respectively [HR 0.63; 95% CI, 0.57-0.70] and 0.6 vs 1.1 events per 100 patient-years, respectively [HR 0.56; 95% CI, 0.50-0.62]).

"Data from ongoing randomized clinical trials will provide further evidence regarding the cardiovascular benefits of different SGLT-2i, including in patients without established CVD," conclude the authors.

Reference

Cavender MA, Norhammar A, Birkeland KI, et al; on behalf of the CVD-Real Investigators and Study Group. SGLT-2 inhibitors and cardiovascular risk: an analysis of CVD-REAL. J Am Coll Cardiol. 2018;71(22):2497-2506.

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