Matthew A Cavender1, Anna Norhammar2, Kåre I Birkeland3, Marit Eika Jørgensen4, John P Wilding5, Kamlesh Khunti6, Alex Z Fu7, Johan Bodegård8, Betina T Blak9, Eric Wittbrodt10, Marcus Thuresson11, Peter Fenici12, Niklas Hammar13, Mikhail Kosiborod14. 1. University of North Carolina, Chapel Hill, North Carolina; Baim Institute of Clinical Research, Boston, Massachusetts. Electronic address: matt.cavender@unc.edu. 2. Karolinska Institutet, Stockholm, Sweden. 3. Institute of Clinical Medicine, University of Oslo, Oslo, Norway, and Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway. 4. Steno Diabetes Center, Copenhagen, Denmark; National Institute of Public Health, University of Southern Denmark, Odense, Denmark. 5. Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, United Kingdom. 6. Diabetes Research Centre, University of Leicester, Leicester, United Kingdom. 7. Georgetown University Medical Center, Washington, DC. 8. AstraZeneca, Oslo, Norway. 9. AstraZeneca, Luton, United Kingdom. 10. AstraZeneca, Wilmington, Delaware. 11. Statisticon AB, Uppsala, Sweden. 12. AstraZeneca, Cambridge, United Kingdom. 13. Karolinska Institutet, Stockholm, Sweden; AstraZeneca, Gothenburg, Sweden. 14. Saint Luke's Mid America Heart Institute, Kansas City, Missouri, and University of Missouri-Kansas City, Kansas City, Missouri.
Abstract
BACKGROUND: Prior studies found patients treated with sodium-glucose co-transporter-2 inhibitors (SGLT-2i) had lower rates of death and heart failure (HF). Whether the benefits of SGLT-2i vary based upon the presence of cardiovascular disease (CVD) is unknown. OBJECTIVES: This study sought to determine the association between initiation of SGLT-2i therapy and HF or death in patients with and without CVD. METHODS: The CVD-REAL (Comparative Effectiveness of Cardiovascular Outcomes in New Users of SGLT-2 Inhibitors) study was a multinational, observational study in which adults with type 2 diabetes were identified. Patients prescribed an SGLT-2i or other glucose-lowering drugs (GLDs) were matched based on a propensity score for initiation of an SGLT-2i. Hazard ratios (HRs) for the risk of death, HF, and HF or death in patients with and without established CVD were estimated for each country and pooled. RESULTS: After propensity score matching, 153,078 patients were included in each group. At baseline, 13% had established CVD. Compared with therapy using other GLDs, initiation of an SGLT-2i was associated with lower risk of death in patients with and without CVD (HR: 0.56; 95% confidence interval [CI]: 0.44 to 0.70; and HR: 0.56; 95% CI: 0.50 to 0.63, respectively). There were also associations between SGLT-2i and lower risk of HF (HR: 0.72; 95% CI: 0.63 to 0.82; and HR: 0.61; 95% CI: 0.48 to 0.78, respectively) and the composite of HF or death (HR: 0.63; 95% CI: 0.57 to 0.70; and HR: 0.56; 95% CI: 0.50 to 0.62, respectively) observed in patients with and without established CVD. CONCLUSIONS: In this large, multinational, observational study, initiation of SGLT-2i was associated with lower risk of death and HF regardless of pre-existing CVD. Ongoing clinical trials will provide further evidence regarding the benefit of SGLT-2i in patients without established CVD. (Comparative Effectiveness of Cardiovascular Outcomes in New Users of SGLT-2 Inhibitors [CVD-REAL]; NCT02993614).
BACKGROUND: Prior studies found patients treated with sodium-glucose co-transporter-2 inhibitors (SGLT-2i) had lower rates of death and heart failure (HF). Whether the benefits of SGLT-2i vary based upon the presence of cardiovascular disease (CVD) is unknown. OBJECTIVES: This study sought to determine the association between initiation of SGLT-2i therapy and HF or death in patients with and without CVD. METHODS: The CVD-REAL (Comparative Effectiveness of Cardiovascular Outcomes in New Users of SGLT-2 Inhibitors) study was a multinational, observational study in which adults with type 2 diabetes were identified. Patients prescribed an SGLT-2i or other glucose-lowering drugs (GLDs) were matched based on a propensity score for initiation of an SGLT-2i. Hazard ratios (HRs) for the risk of death, HF, and HF or death in patients with and without established CVD were estimated for each country and pooled. RESULTS: After propensity score matching, 153,078 patients were included in each group. At baseline, 13% had established CVD. Compared with therapy using other GLDs, initiation of an SGLT-2i was associated with lower risk of death in patients with and without CVD (HR: 0.56; 95% confidence interval [CI]: 0.44 to 0.70; and HR: 0.56; 95% CI: 0.50 to 0.63, respectively). There were also associations between SGLT-2i and lower risk of HF (HR: 0.72; 95% CI: 0.63 to 0.82; and HR: 0.61; 95% CI: 0.48 to 0.78, respectively) and the composite of HF or death (HR: 0.63; 95% CI: 0.57 to 0.70; and HR: 0.56; 95% CI: 0.50 to 0.62, respectively) observed in patients with and without established CVD. CONCLUSIONS: In this large, multinational, observational study, initiation of SGLT-2i was associated with lower risk of death and HF regardless of pre-existing CVD. Ongoing clinical trials will provide further evidence regarding the benefit of SGLT-2i in patients without established CVD. (Comparative Effectiveness of Cardiovascular Outcomes in New Users of SGLT-2 Inhibitors [CVD-REAL]; NCT02993614).
Authors: Hongyan Liu; Vikas S Sridhar; Bruce A Perkins; Julio Rosenstock; David Z I Cherney Journal: Curr Diab Rep Date: 2022-05-28 Impact factor: 4.810
Authors: Luis M Pérez-Belmonte; Michele Ricci; Jaime Sanz-Cánovas; Lidia Cobos-Palacios; María D López-Carmona; M Isabel Ruiz-Moreno; Mercedes Millán-Gómez; M Rosa Bernal-López; Sergio Jansen-Chaparro; Ricardo Gómez-Huelgas Journal: J Clin Med Date: 2021-05-08 Impact factor: 4.241