Prior studies found patients treated with sodium-glucose co-transporter-2 inhibitors ( SGLT-2i ) had lower rates of death and heart failure.
Whether the benefits of SGLT-2 inhibitors vary based upon the presence of cardiovascular disease is unknown.
This study sought to determine the association between initiation of SGLT-2 inhibitors therapy and heart failure or death in patients with and without cardiovascular disease.
The CVD-REAL ( Comparative Effectiveness of Cardiovascular Outcomes in New Users of SGLT-2 Inhibitors ) 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.
After propensity score matching, 153,078 patients were included in each group.
At baseline, 13% had established cardiovascular disease.
Compared with therapy using other glucose-lowering drugs, initiation of an SGLT-2i was associated with lower risk of death in patients with and without cardiovascular disease ( hazard ratio, 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-2 inhibitors and lower risk of heart failure ( 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 heart failure 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 cardiovascular disease.
In conclusion, in this large, multinational, observational study, initiation of SGLT-2 inhibitors was associated with lower risk of death and heart failure regardless of pre-existing cardiovascular disease.
Ongoing clinical trials will provide further evidence regarding the benefit of SGLT-2 inhibitors in patients without established cardiovascular disease. ( Xagena )
Bodegård J et al, J Am Coll Cardiol 2018; 71: 2497-2506