SGLT-2 Inhibitors and Cardiovascular Risk: An Analysis of CVD-REAL
Matthew A Cavender, Anna Norhammar, Kåre I Birkeland, Marit Eika Jørgensen, John P Wilding, Kamlesh Khunti, Alex Z Fu, Johan Bodegård, Betina T Blak, Eric Wittbrodt, Marcus Thuresson, Peter Fenici, Niklas Hammar, Mikhail Kosiborod, CVD-REAL Investigators and Study Group, Mikhail Kosiborod, Matthew A Cavender, Alex Z Fu, John P Wilding, Kamlesh Khunti, Anna Norhammar, Kåre I Birkeland, Marit Eika Jørgensen, Reinhard W Holl, Niklas Hammar, Peter Fenici, Hungta Chen, Johan Bodegård, Betina T Blak, Eric T Wittbrodt, Markus F Scheerer, Filip Surmont, Kyle Nahrebne, Hanne Løvdal Gulseth, Bendix Carstensen, Marcus Thuresson, Esther Bollow, Luis Alberto García Rodríguez, Lucia Cea Soriano, Oscar Fernándex Cantero, Ellen Thiel, Brian Murphy, Matthew A Cavender, Anna Norhammar, Kåre I Birkeland, Marit Eika Jørgensen, John P Wilding, Kamlesh Khunti, Alex Z Fu, Johan Bodegård, Betina T Blak, Eric Wittbrodt, Marcus Thuresson, Peter Fenici, Niklas Hammar, Mikhail Kosiborod, CVD-REAL Investigators and Study Group, Mikhail Kosiborod, Matthew A Cavender, Alex Z Fu, John P Wilding, Kamlesh Khunti, Anna Norhammar, Kåre I Birkeland, Marit Eika Jørgensen, Reinhard W Holl, Niklas Hammar, Peter Fenici, Hungta Chen, Johan Bodegård, Betina T Blak, Eric T Wittbrodt, Markus F Scheerer, Filip Surmont, Kyle Nahrebne, Hanne Løvdal Gulseth, Bendix Carstensen, Marcus Thuresson, Esther Bollow, Luis Alberto García Rodríguez, Lucia Cea Soriano, Oscar Fernándex Cantero, Ellen Thiel, Brian Murphy
Abstract
Background: Prior studies found patients treated with sodium-glucose co-transporter-2 inhibitors (SGLT-2i) had lower rates of death and heart failure (HF). Whether the benefits of SGLT-2i vary based upon the presence of cardiovascular disease (CVD) is unknown.
Objectives: This study sought to determine the association between initiation of SGLT-2i therapy and HF or death in patients with and without CVD.
Methods: The CVD-REAL (Comparative Effectiveness of Cardiovascular Outcomes in New Users of SGLT-2 Inhibitors) study was a multinational, observational study in which adults with type 2 diabetes were identified. Patients prescribed an SGLT-2i or other glucose-lowering drugs (GLDs) were matched based on a propensity score for initiation of an SGLT-2i. Hazard ratios (HRs) for the risk of death, HF, and HF or death in patients with and without established CVD were estimated for each country and pooled.
Results: After propensity score matching, 153,078 patients were included in each group. At baseline, 13% had established CVD. Compared with therapy using other GLDs, initiation of an SGLT-2i was associated with lower risk of death in patients with and without CVD (HR: 0.56; 95% confidence interval [CI]: 0.44 to 0.70; and HR: 0.56; 95% CI: 0.50 to 0.63, respectively). There were also associations between SGLT-2i and lower risk of HF (HR: 0.72; 95% CI: 0.63 to 0.82; and HR: 0.61; 95% CI: 0.48 to 0.78, respectively) and the composite of HF or death (HR: 0.63; 95% CI: 0.57 to 0.70; and HR: 0.56; 95% CI: 0.50 to 0.62, respectively) observed in patients with and without established CVD.
Conclusions: In this large, multinational, observational study, initiation of SGLT-2i was associated with lower risk of death and HF regardless of pre-existing CVD. Ongoing clinical trials will provide further evidence regarding the benefit of SGLT-2i in patients without established CVD. (Comparative Effectiveness of Cardiovascular Outcomes in New Users of SGLT-2 Inhibitors [CVD-REAL]; NCT02993614).
Keywords: CVD-REAL; cardiovascular disease; heart failure; sodium-glucose co-transporter-2 inhibitors.
Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.
Source: PubMed