SGLT2 inhibitors: reduced cardiovascular risk, mortality across T2D subgroups

  • Arnott C & al.
  • J Am Heart Assoc
  • 4 Feb 2020

  • curated by Miriam Tucker
  • Clinical Essentials
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Takeaway

  • Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are linked to reduced risk for cardiovascular disease (CVD) and death.
  • Reductions seen in diverse patient subsets with type 2 diabetes (T2D), regardless of CVD history.

Why this matters

  • Uncertainty remains about SGLT2i benefits in patients without established baseline CVD.

Study design

  • Meta-analysis of 4 large-scale CVD outcome trials of SGLT2i vs placebo in 38,723 patients with T2D and a mean follow-up of 2.9 years, including 59% with CVD, 20% with reduced kidney function, and 12% with heart failure (HF).
  • Funding: Australian National Health and Medical Research Council.

Key results

  • SGLT2is were associated with risk reductions (HRs; 95% CIs) in:
    • Major adverse cardiac events (MACE): 0.88 (0.82-0.94);
    • Cardiovascular death: 0.83 (0.75-0.92);
    • Myocardial infarction: 0.88 (0.80-0.97);
    • HF hospitalization: 0.68 (0.60-0.76); and
    • All-cause mortality: 0.85 (0.79-0.92).
  • No risk reduction for stroke: 0.96 (0.86-1.09).
  • Only efficacy outcome difference with or without baseline CVD was for cardiovascular death:
    • HR, 0.80 (95% CI, 0.71-0.90) with baseline CVD vs 0.95 (0.77-1.17) without.
  • MACE and stroke risk reductions (HRs; 95% CIs) were greater in patients with reduced vs preserved kidney function:
    • MACE: 0.80 (0.70-0.90) reduced vs 0.92 (0.85-0.99) preserved.
    • Stroke: 0.75 (0.59-0.96) reduced vs 1.05 (0.91-1.20) preserved.

Limitations

  • Few events among those without baseline CVD.
  • Limited baseline HF.