How SGLT2 Inhibitors Impact CVD Risk in Diabetes Patients

Patients with type 2 diabetes taking sodium-glucose co-transporter-2 (SGLT2) inhibitors had a lower risk for cardiovascular mortality compared with patients taking other glucose-lowering drugs, according to the findings of a recent study.

In their study, researchers analyzed data from 22,830 patients who filled a prescription for SGLT2 inhibitors and 68,490 patients who filled a prescription for other glucose-lowering drugs between 2012 and 2015 (Lancet Diabetes Endocrinol. https://dx.doi.org/10.1016/S2213-8587(17)30258-9). The mean age of patients was 61 years, 40% of patients were women, and the prevalence of cardiovascular disease was 25%.

Patients were divided into new users of SGLT2 inhibitors and new users of other glucose-lowering drugs, and followed until December 31, 2015. Cardiovascular mortality, major adverse cardiovascular events, hospital events for heart failure, non-fatal myocardial infarction, non-fatal stroke, and atrial fibrillation were assessed, as well as incidence of severe hypoglycemia.

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Over a mean 0.9 years of follow-up, 94% of the total SGLT2 exposure time was for the use of dapagliflozin, 5% was for the use of empagliflozin, and 1% was for the use of canagliflozin.

The use of SGLT2 inhibitors was associated with a decreased risk of cardiovascular mortality, major cardiovascular events, and hospitalization for heart failure compared with other glucose-lowering drugs. Hazard ratios (HR) for cardiovascular mortality were similar for those with cardiovascular disease at baseline compared and those without cardiovascular disease at baseline (HR 0.60 vs HR 0.55), while hazard ratios for major adverse cardiovascular events differed between those with cardiovascular disease at baseline and those without (HR 0.70 vs HR 0.90).

However, the researchers did not find any significant differences between the use of SGLT2 inhibitors and other glucose-lowering drugs for non-fatal myocardial infarction, non-fatal stroke, or atrial fibrillation.

“In a population of patients with type 2 diabetes and a broad cardiovascular risk profile, SGLT2 inhibitor use was associated with reduced cardiovascular disease and cardiovascular mortality compared with use of other glucose-lowering drugs—a finding consistent with the results of clinical trials in patients at high cardiovascular risk,” the researchers concluded.

—Melissa Weiss