Sodium-glucose cotransporter-2 (SGLT2) inhibitors reduce the risk for heart failure (HF) hospitalization and death in patients with type 2 diabetes (T2D) and with either reduced or preserved ejection fraction, according to study results presented at the American College of Cardiology 68th Annual Scientific Session held March 16-18, 2019, in New Orleans, Louisiana.
SGLT2 inhibitors have been associated with a lower risk for hospitalization from HF in T2D, but no prior studies have examined this effect across differing levels of left ventricular ejection fraction. In this study, researchers compared the risk for HF hospitalizations and death in patients with available ejection fraction data treated with SGLT2 inhibitors vs other types of glucose-lowering drugs. Baseline ejection fraction measurements were stratified as ≤40% or >40%.
After propensity score matching, there were 6563 cases of treatment initiation in each subgroup (N=13,126). Mean T2D duration was 11 years and mean hemoglobin A1c was 8.1%. In total, 528 patients had ejection fraction measurements ≤40% and 1190 had ejection fraction measurements ≤50%.
In the SGLT2 inhibitor treatment group, 37% of cases received dapagliflozin and 63% received empagliflozin. For patients receiving other glucose-lowering drugs, 29% were treated with dipeptidyl peptidase-4 inhibitors, 17% with glucagon-like peptide-1 receptor agonists, 14% with metformin, 11% with insulin, 10% with sulfonylureas, and 7% with thiazolidinediones.
After an average follow-up of 1.5 years, there were 432 cases of death or hospitalization for HF, and patients with ejection fraction ≤40% accounted for 16.4% of these cases. Initiation of SGLT2 inhibitors was associated with a lower risk for HF hospitalization or death (hazard ratio [HR] 0.54; 95% CI, 0.44-0.65; P <.001) vs other glucose-lowering drugs. The association was significant in both patients with an ejection fraction ≤40% (HR 0.50; 95% CI, 0.32-0.78) and >40% (HR 0.53; 95% CI, 0.43-0.66). The effects remained when ejection fraction was categorized as ≤50% or >50% and when the analysis was restricted to include only patients with a history of HF.
The researchers concluded that their findings using real world clinical practice data “suggest that HF prevention benefits of [SGLT2 inhibitors] may extend across the range of baseline [ejection fraction].”
Lam CSP, Karasik A, Cavender M, et al. Initiation of sodium glucose cotransporter-2 inhibitors versus other glucose lowering drugs and risk of hospitalization for heart failure and death in patients with type 2 diabetes with reduced and preserved left ventricular ejection fraction. Presented at: American College of Cardiology 68th Annual Scientific Session. March 16-18, 2019; New Orleans, LA. Abstract 1024-07.