Cardiovascular Outcomes With SGLT2 Inhibitors in T2D Compared

Cardiogenic Shock
Human heart computer illustration.
A network meta-analysis was done to compare the effectiveness of SGLT2 inhibitors in participants with type 2 diabetes and cardiovascular risk factors.

The following article is a part of conference coverage from the American Heart Association Scientific Sessions 2021, being held virtually from November 13 to 15, 2021. The team at Cardiology Advisor will be reporting on the latest news and research conducted by leading experts in cardiology. Check back for more from the AHA Scientific Sessions 2021.

Therapy with the sodium-glucose cotransporter-2 (SGLT2) inhibitor ertugliflozin lowers the risk for major adverse cardiovascular events (MACE) and hospitalization for heart failure (HHF), compared with dapagliflozin, which only decreases HHF risk, and canagliflozin, which only decreases the risk for all-cause mortality, according to study results presented at AHA 2021, held from November 13 to 15, 2021.

A network meta-analysis was done to compare the effectiveness and safety of SGLT2 inhibitors in participants with type 2 diabetes mellitus (DM) and cardiovascular risk factors. Investigators searched digital databases for relevant publications comparing all-cause mortality, MACE, and HHF. A multivariate random-effect model was used to calculate unadjusted odds ratios (ORs).

Nineteen studies (N=489,621; 58.1 years average) met the search criteria. SGLT2 inhibitors compared included empagliflozin (n=13,419), canagliflozin (n=79,661), dapagliflozin (n=40,915), sotagliflozin (n=5840), and ertugliflozin (n=5499). Compared with placebo, dapagliflozin and ertugliflozin both significantly decreased HHF risk (dapagliflozin: OR 0.64; 95% CI, 0.47-0.87; ertugliflozin: OR 0.57; 95% CI, 0.41-0.81); canagliflozin significantly lowered the all-cause mortality rate (OR 0.79; 95% CI, 0.64-0.98); and ertugliflozin significantly lowered MACE risk (OR 0.67; 95% CI, 0.51-0.88).

No other comparisons between SGLT2 inhibitors and placebos reached statistical significance. Investigators used intergroup analyses across types of SGLT2 inhibitors to discover there were no significant differences in all-cause mortality, HHF, or MACE.

Study investigators concluded, “In addition to guideline-directed medical therapy, ertugliflozin lowers the risk [for] HHF and MACE, whereas dapagliflozin and canagliflozin decrease HHF only, and all-cause mortality only, respectively.”


Sattar Y, Song D, Ahmed B, et al. Comparative effectiveness of sodium-glucose cotransporter-2 inhibitors for cardiovascular outcomes in type 2 diabetes mellitus: a network meta-analysis. Presented at: AHA 2021; November 13-15, 2021. Poster P1629.


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