SGLT2 inhibitors may decrease heart failure risk
The use of sodium-glucose co-transporter 2 (SGLT2) inhibitors such as empagliflozin and canagliflozin may lead to a decreased risk of heart failure (HF), according to data presented at the Asian Pacific Society of Cardiology Congress (APSC) 2017 held in Singapore.
“Empagliflozin, canagliflozin, and maybe metformin, are … beneficial [in reducing HF risk],” said Dr Darren McGuire from the University of Texas Southwestern Medical Center in Dallas, Texas, US, who highlighted the decreased HF risk with antihyperglycaemic agents as shown in the EMPA-REG OUTCOME* and CVD-REAL** trials.
In the EMPA-REG OUTCOME trial, 7,020 patients with prevalent atherosclerotic vascular disease and type 2 diabetes were randomized to receive placebo (n=2,333), empagliflozin 10 mg once daily (n=2,345), or empagliflozin 25 mg once daily (n=2,342). [N Engl J Med 2015;373:2117-2128; Cardiovasc Diabetol 2014;13:102]
The lower risk of HF among patients on empagliflozin was observed within the first 6–9 months of the trial (hazard ratio [HR], 0.65, 95 percent confidence interval [CI], 0.50–0.85; p=0.0017).
“[This] continued to divert slightly throughout the follow-up period … leading to the 35 percent relative risk reduction in incident [HF],” said McGuire, who suggested an increase in haematocrit (4 percent) as a potential reason for the reduction in HF. “This was a stunning finding … [W]e were very interested [to determine if] this was unique to empagliflozin or [if it was] a class effect.”
In the CVD-REAL trial, 154,528 participants receiving an SGLT2 inhibitor were matched with 154,528 individuals receiving other glucose-lowering drugs. [Circulation 2017;136:249-259]
Overall results revealed a decreased risk of hospitalization for HF with SGLT2 inhibitors (HR, 0.61, 95 percent CI, 0.51–0.73; p<0.001), which is also suggestive of a class effect, noted McGuire.
Given the favourable cardiovascular outcomes resulting from SGLT2 antagonist use, the European Society of Cardiology (ESC) HF prevention guidelines encourage the use of this class of glucose-control drugs, specifically empagliflozin, for cardiovascular death and HF risk reduction, noted McGuire.
McGuire pointed out that the benefits of metformin in this aspect warrants further investigation. “[There is] emerging data suggesting metformin may be in fact beneficial … [however], to this day, we have no idea what the cardiovascular safety or efficacy of metformin is, specifically [in relation] to HF.”