Cardiovascular Outcomes of SGLT-2i vs Other Glucose-Lowering Drugs in T2D

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In all 6 countries, hazard ratios favored SGLT-2i over other glucose-lowering drugs in all outcomes measured.
In all 6 countries, hazard ratios favored SGLT-2i over other glucose-lowering drugs in all outcomes measured.

In a recent international study of patients with type 2 diabetes (T2D) from the Asia-Pacific, Middle East, and North America, initiation of sodium-glucose cotransporter-2 inhibitors (SGLT-2i) was linked to a lower risk for cardiovascular (CV) events, according to research presented at the 2018 American College of Cardiology 67th Annual Scientific Session & Expo, held March 10-12, in Orlando, Florida.

Mikhail Kosiborod, MD of St Luke's Cardiovascular Consultants in Lees Summit, Missouri, and colleagues aimed to evaluate the effects of SGLT-2i and other glucose-lowering drugs, including oral and injectable drug classes, on CV events in patients with T2D from South Korea, Japan, Singapore, Israel, Australia, and Canada.

The primary outcomes included all-cause death, which was available for all countries, and hospitalization for heart failure (HF), death or hospitalization for HF, myocardial infarction (MI), and stroke, which was available for all countries except Australia. Data were obtained from 235,064 episodes of SGLT-2i initiation, which was composed of dapagliflozin (75%), empagliflozin (9%), ipragliflozin (8%), canagliflozin (4%), tofogliflozin (3%), and luseogliflozin (1%), and 3,668,208 episodes of initiation with other glucose-lowering drugs.

After analysis, initiation of SGLT-2i vs other glucose-lowering drugs was linked to a lower risk for all-cause death (hazard ratio [HR] 0.51; 95% CI, 0.37-0.70, P <.001) and hospitalization for HF (HR 0.64; 95% CI, 0.50-0.82, P =.001), as well as for death or hospitalization for HF (HR 0.60; 95% CI, 0.47-0.76, P <.001). The risk for MI (HR 0.81; 95% CI, 0.74-0.88, P <.001) and stroke (HR 0.68; 95% CI, 0.55-0.84; P <.001) was also lower. In all 6 countries, HRs consistently favored SGLT-2i over other glucose-lowering drugs in all outcomes measured.

These findings are limited by a few factors, including only measuring CV outcomes and not evaluating safety, and having a limited number of patient-years of follow up, considering use of SGLT-2i in clinical practice is relatively recent.

Use of SGLT-2i was associated with a lower risk for cardiovascular outcomes in patients with T2D living in 6 countries from 3 major world regions compared with other glucose-lowering drugs.

“Our results suggest that the cardiovascular benefits of SGLT-2i may be applicable to a considerably broader patient population than previously considered,” concluded the researchers.

Disclosure: This study was funded by AstraZeneca.

Reference

Kosiborod M, Lam CSP, Kohsaka S, et al. Lower cardiovascular risk associated with SGLT-2i in >400,000 patients: the CVD-REAL 2 study.  Presented at: 2018 American College of Cardiology 67th Annual Scientific Session & Expo; March 10-12, 2018; Orlando, Florida. Abstract 14372.

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