Type 2 diabetes: dapagliflozin may lower hospitalisation risk for heart failure

  • Wiviott SD & al.
  • N Engl J Med
  • 10 Nov 2018

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • In patients with type 2 diabetes (T2D) who were at increased risk for atherosclerotic cardiovascular disease (CVD), dapagliflozin significantly reduced risk for cardiovascular death or hospitalisation for heart failure but did not lower major adverse cardiovascular events (MACE).

Why this matters

  • Sodium-glucose cotransporter 2 inhibitors have shown promising CV benefits, including a reduction in risk of hospitalisation for heart failure in patients with T2D and without established CVD.
  • They also delayed the progression of kidney disease.

Study design

  • 17,160 patients with T2D (with CVD, n=6974; without CVD; n=10,186) were randomly assigned to receive dapagliflozin (n=8582) and placebo (n=8578).
  • Primary outcomes: MACE (composite of CV death, myocardial infarction, or ischemic stroke) and composite of CV death or hospitalisation for heart failure.
  • Secondary outcomes: composite renal outcomes (≥ 40% estimated glomerular filtration rate) and death from any cause.
  • Funding: AstraZeneca.

Key results

  • Compared with placebo, dapagliflozin significantly reduced the risk for:
  • composite of CV death or hospitalisation for heart failure (HR, 0.83; P=.005) and
  • hospitalisation for heart failure (HR, 0.73; 95% CI, 0.61-0.88).
  • There was no significant difference in risk for MACE (HR, 0.93; P=.17) and CV death (HR, 0.98; 95% CI, 0.82-1.17) between both the groups.
  • Dapagliflozin likely reduced the incidence of composite renal outcomes vs placebo (HR, 0.76; 95% CI, 0.67-0.87).
  • No significant difference was seen in death from any cause between 2 groups (HR, 0.93; 95% CI, 0.82-1.04).

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