Canagliflozin reduces HF risk, regardless of EF status

  • Figtree GA & al.
  • Circulation
  • 17 Mar 2019

  • International Clinical Digest
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Takeaway

  • Canagliflozin (e.g., Invokana) reduces overall risk for heart failure (HF) events in patients with type 2 diabetes (T2D) and high cardiovascular risk.
  • The results show no risk reduction differences between preserved vs reduced ejection fraction (EF).

Why this matters

  • Patients with T2D are at high risk for HF.
  • Sodium glucose cotransporter 2 inhibitors reduce HF events in patients with T2D and cardiovascular disease, but differences between HF with preserved vs reduced EF (HFpEF vs HFrEF) are unclear.

Study design

  • Data from the CANagliflozin cardioVascular Assessment Study Program, including 10,142 patients with mean 188.2-week follow-up.  
  • HFpEF: HF event with EF ≥50%; HFrEF: HF event with EF
  • Other events defined as HF with unknown EF (HFuEF).
  • Funding: Janssen Research and Development, LLC.

Key results

  • Overall 2.7% (276) had a fatal or hospitalized HF event during follow-up; 0.60% (61) had >1 HF event.
  • Canagliflozin reduced fatal or hospitalized HF events vs placebo:
    • HR, 0.70 (95% CI, 0.55-0.89).
  • Event HRs (95% CIs) for canagliflozin vs placebo were: 
    • HFrEF: 0.69 (0.48-1.00); 
    • HFpEF: 0.83 (0.55-1.25); and
    • HFuEF: 0.54 (0.32-0.89).  

Limitations

  • EF measurements only at time of event, not baseline.