Dapagliflozin reduces adverse CV outcomes with T2D and prior MI

  • Furtado RHM & al.
  • Circulation
  • 18 Mar 2019

  • International Clinical Digest
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Takeaway

  • Dapagliflozin (Farxiga) significantly reduces risks for major adverse cardiovascular events (MACE) and cardiovascular (CV) death/hospitalizations for heart failure (HHF) in patients with type 2 diabetes (T2D) and prior myocardial infarction (MI).

Why this matters

  • Patients with T2D and prior MI are at high risk for adverse outcomes.

Study design

  • DECLARE TIMI-58 randomized 17,160 patients with T2D and either established atherosclerotic CV disease or multiple risk factors to dapagliflozin vs placebo.
  • Coprimary endpoints were composite of MACE (CV death, MI, or ischemic stroke) and composite of CV death or HHF.
  • Funding: AstraZeneca.

Key results

  • Overall HR for MACE with dapagliflozin was 0.93 (P=.17).
  • Among 3584 patients with prior MI, MACE occurred in:
    • 15.2% with dapagliflozin;  
    • 17.8% placebo;
    • HR 0.84 (P=.039). 
    • No effect in patients without prior MI (7.1% vs 7.1%, HR 1.00, P=.97).
  • Dapagliflozin reduced CV death/HHF in patients with and without prior MI:
    • HRs, 0.81 vs 0.85, respectively (relative Pinteraction=.69).
  • Absolute risk reductions:
    • 1.9% for patients with prior MI with dapagliflozin (8.6% had events vs 10.5% placebo). 
    • 0.6% without MI (3.9% had events with dapagliflozin vs 4.5% with placebo; Pinteraction=.010).

Limitations

  • Subgroup analysis underpowered for some outcomes.
  • Patients with prior MI within 8 weeks after index-event excluded.