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