SGLT-2 inhibitors cut risk of hospitalization for HF, death in real-world study
Treatment with sodium- glucose cotransporter 2 (SGLT-2) inhibitors reduces the risk of hospitalization for heart failure (hHF) and death compared with other glucose-lowering drugs, the retrospective, observational CVD-REAL* study has shown.
Overall, there were 734 new hHF cases (incidence rate 0.41/100 person years). New users of SGLT-2 inhibitors (dapagliflozin, canagliflozin and empagliflozin) had a 39 percent lower rate of incident hHF vs new users of other glucose-lowering drugs (pooled hazard ratio [HR, 0.61; p<0.001). Similarly, rate of death from any cause (HR, 0.49; p<0.001) was lower with the SGLT-2 inhibitors as was the composite endpoint of hHF and death from any cause (HR, 0.54; p<0.001). [ACC.17, abstract 415-14]
The cardiovascular benefits appeared to be class-related than compound-specific, said lead investigator Dr Mikhail Kosiborod from the University of Missouri-Kansas City School of Medicine, Kansas City, US.
“There was no significant heterogeneity across countries despite geographic variations in use of SGLT-2 inhibitors [canagliflozin was predominantly used in the US, dapagliflozin in Europe],” he said. “This was in a broad population of patients in general practice with type 2 diabetes [T2D], the overwhelming majority of whom did not have known cardiovascular disease [CVD].”
The researchers compared the risk of hHF, all-cause death, and the composite of hHF and death in over 300,000 patients with T2D who were newly prescribed SGLT-2 inhibitors (n=154,523) or other glucose-lowering drugs (n=154,523). Data from large registries of patients across six countries (US, Germany, Sweden, Norway, Denmark, and the UK) were pooled and analysed.
Nonparsimonious propensity scores for initiation of SGLT-2 inhibitors were used to match the two treatment groups. At baseline, 80 percent of the patients were receiving an antihypertensive, 67 percent were on a statin, and almost 80 percent were on metformin therapy. The mean age of the patients was 57; 44 percent were women.
Most patients in the US were treated with canagliflozin (75.9 percent) while almost all patients in Europe received dapagliflozin (91.9 percent). Overall, 52.7 percent of the patients were treated with canagliflozin, 41.8 with dapagliflozin, and 5.5 percent with empagliflozin.
In this large multicountry cohort, treatment with SGLT-2 inhibitors was associated with marked and highly significant reductions in HHF and death. “This is interesting as what you’re seeing in terms of HF hospitalization is primarily a heart-prevention signal rather than a heart-treatment signal,” Kosiborod said.
“I believe this class [SGLT-2 inhibitor] has a really remarkable potential to transform how we manage diabetes and patient outcomes,” he added, suggesting that more data from multiple sources are warranted to drive the message home.In the meantime, cardiologists await with enthusiasm the results of the ongoing CV safety studies with canagliflozin (CANVAS) and dapagliflozin (DECLARE-TIMI 58) to establish whether the benefits observed with SGLT-2 inhibitors are indeed a class-effect of the drugs.