- Primary benefit of sodium-glucose cotransporter-2 inhibitor (SGLT2is) appears to be reduction in hospitalization for heart failure (h[HF]) and possibly cardiovascular (CV) mortality, but not atherosclerotic CV disease.
Why this matters
- A previous meta-analysis suggested that SGLT2is reduce atherosclerotic events in addition to other CV endpoints.
- Editorial called for SGLT2i use as first-line therapy after metformin in type 2 diabetes (T2D), even among patients at lower CV risk.
- Meta-analyses of 3 CV outcome trials (n=34,322) and pooled phase 3 data for all available gliflozins (n=23,334), plus examination of supplementary materials, regulatory analysis, and mechanistic data.
- Funding: None.
- HR for major adverse cardiac events (MACE) was statistically significant (0.89; P=.002).
- Significant reduction in nonfatal myocardial infarction (MI) (0.87; P=.01) but no improvement for nonfatal stroke (1.01; P=.83).
- In one
trial, significant reduction in “CV death or hHF” composite endpoint (0.76; P<.001 but driven primarily by hhf vs cv death>
- In phase 3 pooled analysis, significant results for MI (0.664; P=.014), CV death (0.637; P=.038), and hHF (0.360; P=.002).
- Insignificant effects for MACE (0.832; P=.103) and stroke (1.172; P=.403).
- Inclusion of short-duration studies.
- Analysis of aggregate rather than individual patient data.