- Sodium-glucose cotransporter-2 inhibitors (SGLT2is) are moderately protective against cardiovascular disease (CVD) events in patients with type 2 diabetes (T2D) and atherosclerosis (AS).
- Drugs also show protection against heart failure (HF) hospitalization and renal disease progression in patients with no ASCVD or HF history.
Why this matters
- Accompanying editorial says the drugs should “now be considered as first-line therapy after metformin” in T2D with or without existing ASCVD, HF, or chronic kidney disease (CKD).
- The therapy seems to address the “pump, pipe, and filter” problems of T2D.
- For patients with ASCVD, SGLT2i reduced major CVD events: HR, 0.86 (95% CI, 0.80-0.93).
- No such benefit without ASCVD: HR, 1.00 (0.87-1.16).
- However, HF hospitalization risk decreased with SGLT2i, either with (HR, 0.71; 95% CI, 0.62-0.82) or without (0.64; 0.48-0.85) ASCVD.
- Renal disease progression risk also decreased with SGLT2i (HR, 0.55; 95% CI, 0.48-0.64, P<.0001 also regardless of ascvd hr class="">0.56; 0.47-0.67; without: 0.54; 0.42-0.71).
- Systematic review, meta-analysis of 3 randomized, placebo-controlled trials ( EMPA-REG OUTCOME , CANVAS , DECLARE-TIMI58 ); n=34,322 (60.2% with ASCVD; mean age, 63.5 years; 35.1% women).
- Funding: None; some authors declare industry ties.
- High intertrial heterogeneity.
- Not individual-level data.
- Trials varied in inclusion criteria, definitions.