Iskandar Idris1, Ruiqi Zhang2,3, Jil Billy Mamza3, Mike Ford3, Tamsin Morris3, Amitava Banerjee4,5, Kamlesh Khunti6, Jonathan Tulip Mark Greener7. 1. Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Royal Derby Hospital, Derby, United Kingdom. 2. Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom. 3. AstraZeneca, Luton, United Kingdom. 4. Institute of Health Informatics, University College, London, United Kingdom. 5. Department of Cardiology, University College London Hospitals, London, United Kingdom. 6. Diabetes Research Centre, University of Leicester, Leicester, United Kingdom. 7. Medical writing support Mr Jonathan Tulip and Mr Mark Greener Omegascientific UK ltd.
Abstract
BACKGROUND: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) reduce the risk of cardiovascular and, or renal disease (CVRD). Dipeptidyl peptidase-4 inhibitors (DPP4i) have not shown these effects. METHODS: This retrospective cohort study propensity matched 24,438 patients receiving a SGLT2i 1:1 to a person receiving a DDP4i, stratified based on presence of CVRD. Primary outcomes were the time to each of the following: all-cause mortality, cardiovascular death or hospitalisation for heart failure (HF), myocardial infarction, stroke and chronic kidney disease (CKD). FINDINGS: Overall, SGLT2i were associated with reductions in all-cause mortality, cardiovascular mortality , HF hospitalisation and CKD hospitalisation compared with DPP4i. In patients with no CVRD history, SGLT2i were associated with reductions in all-cause mortality (0·71, 0·57-0·88; p=0·002), HF hospitalisation (0·76, 0·59-0·98; p=0·035) and CKD hospitalisation (0·75, 0·63-0·88; p<0·001). In patients with established cardiovascular disease (CVD) or at high risk, SGLT2i were associated with reductions in all-cause mortality (0·69, 0·59-0·82); p<0·001), cardiovascular mortality (0·76, 0·62-0·95; p=0·014), HF hospitalisation (0·73, 0·63-0·85; p<0·001), stroke hospitalisation (0·75, 0·59-0·94, p=0·013) and CKD hospitalisation (0·49, 0·43-0·54, p<0·001). Results were consistent across subgroups and sensitivity analyses. INTERPRETATION: SGLT2i were associated with reduced risk of all-cause mortality and hospitalisation for HF and CKD compared with DPP4-i, highlighting the need to introduce SGLT2i early in the management of T2D patients. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
BACKGROUND:Sodium-glucose cotransporter-2 inhibitors (SGLT2i) reduce the risk of cardiovascular and, or renal disease (CVRD). Dipeptidyl peptidase-4 inhibitors (DPP4i) have not shown these effects. METHODS: This retrospective cohort study propensity matched 24,438 patients receiving a SGLT2i 1:1 to a person receiving a DDP4i, stratified based on presence of CVRD. Primary outcomes were the time to each of the following: all-cause mortality, cardiovascular death or hospitalisation for heart failure (HF), myocardial infarction, stroke and chronic kidney disease (CKD). FINDINGS: Overall, SGLT2i were associated with reductions in all-cause mortality, cardiovascular mortality , HF hospitalisation and CKD hospitalisation compared with DPP4i. In patients with no CVRD history, SGLT2i were associated with reductions in all-cause mortality (0·71, 0·57-0·88; p=0·002), HF hospitalisation (0·76, 0·59-0·98; p=0·035) and CKD hospitalisation (0·75, 0·63-0·88; p<0·001). In patients with established cardiovascular disease (CVD) or at high risk, SGLT2i were associated with reductions in all-cause mortality (0·69, 0·59-0·82); p<0·001), cardiovascular mortality (0·76, 0·62-0·95; p=0·014), HF hospitalisation (0·73, 0·63-0·85; p<0·001), stroke hospitalisation (0·75, 0·59-0·94, p=0·013) and CKD hospitalisation (0·49, 0·43-0·54, p<0·001). Results were consistent across subgroups and sensitivity analyses. INTERPRETATION: SGLT2i were associated with reduced risk of all-cause mortality and hospitalisation for HF and CKD compared with DPP4-i, highlighting the need to introduce SGLT2i early in the management of T2D patients. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
Authors: Melanie J Davies; Heinz Drexel; François R Jornayvaz; Zoltan Pataky; Petar M Seferović; Christoph Wanner Journal: Cardiovasc Diabetol Date: 2022-08-04 Impact factor: 8.949