SGLT2 inhibitors show CVD, renal protection in T2D

  • Lancet

  • curated by Emily Willingham, PhD
  • Clinical Essentials
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • 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. 

Key results

  • 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).

Study design

  • 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.

Limitations

  • High intertrial heterogeneity.
  • Not individual-level data.
  • Trials varied in inclusion criteria, definitions.

Please confirm your acceptance

To gain full access to GPnotebook please confirm:

By submitting here you confirm that you have accepted Terms of Use and Privacy Policy of GPnotebook.

Submit