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