SGLT2 inhibitors are linked to some CV benefits - real-world data

  • Pasternak B & al.
  • BMJ
  • 29 Aug 2019

  • International Clinical Digest
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Takeaway

  • Sodium glucose cotransporter 2 inhibitors (SGLT2is) are associated with reduced risks for heart failure (HF) and any-cause death vs dipeptidyl peptidase-4 inhibitors (DPP4is).
    • They were not associated with major cardiovascular (CV) events in primary intention-to-treat analysis.
    • In as-treated analyses, however, the associations strengthened, and reduced CV death risk was seen.

Why this matters

  • Prior real-world studies have been flawed.

Study design

  • Observational study; 20,983 new SGLT2i users propensity-matched 1:1 with new DPP4i users.
  • Primary outcomes: major CV events (myocardial infarction, stroke, CV death composite) and HF-related hospitalisation or death.
  • Secondary outcomes: individual components of CV composite and any-cause death.
  • Funding: Swedish Heart-Lung Foundation; Novo Nordisk Foundation; Swedish Society for Medical Research.

Key results

  • Event rates per 1000 person-years:
    • Major CV events: 17.0 for SGLT2i users vs 18.0 for DPP4i users.
      • HR vs DPP4is: 0.94 (95% CI, 0.84-1.06). 
    • HF: 4.7 vs 7.1.  
      • HR: 0.66 (0.53-0.81).
  • HRs (95% CIs) for secondary outcomes, SGLT2i vs DPP4is:
    • Myocardial infarction: 0.99 (0.85-1.17);
    • Stroke: 0.94 (0.77-1.15);
    • CV death: 0.84 (0.65-1.08); and
    • Any-cause death: 0.80 (0.69-0.92).
  • As-treated analysis, HRs (95% CIs):
    • Major CV events composite: 0.84 (0.72-0.98), primarily driven by CV deaths; and
    • HF: 0.55 (0.42-0.73).

Limitations

  • Possible residual confounding.
  • Relatively short follow-up (median, 1.1 years).

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