SGLT-2 inhibitors may lower heart failure, death rates in T2D patients regardless of CVD status
Sodium-glucose transporter-2 inhibitors (SGLT-2i) were associated with a significant reduction in the rates of death and hospitalization due to heart failure (HF) in patients with type 2 diabetes (T2D) regardless of pre-existing cardiovascular disease (CVD), according to a new analysis of the CVD-REAL* study presented at the American Diabetes Association’s 77th Scientific Sessions held in San Diego, California, US.
“The benefits seen with [SGLT-2i] are likely to be a class effect,” said Dr Matthew Cavender from the University of North Carolina School of Medicine, Chapel Hill, North Carolina, US, as the association remained consistent despite the geographic variations relative to the specific SGLT-2i used and the lack of heterogeneity across participating countries.
In this multinational (US, UK, Norway, Sweden, and Denmark) study, researchers evaluated 306,156 participants with T2D who had undergone SGLT-2i treatment. Of these, 13 percent (n=39,293) had established CVD, and 950 new HF events were reported. HF and death rates in patients with and without prior CVD history were compared against HF rates in new users of SGLT-2i and other glucose-lowering drugs (oGLD).
Compared with oGLD, SGLT-2i was associated with decreased HF rates in patients with and without prior CVD (hazard ratio [HR], 0.69, 95 percent confidence interval [CI], 0.59–0.80 and HR, 0.45, 95 percent CI, 0.32–0.63, respectively). [ADA 2017, abstract 377-OR]
Similar results were observed for death with and without existing CVD (HR, 0.47, 95 percent CI, 0.36–0.61 and HR, 0.54, 95 percent CI, 0.44–0.66, respectively) with SGLT-2i vs oGLD use.
SGLT-2i use also resulted in decreased rates of death due to HF with and without existing CVD (HR, 0.59, 95 percent CI, 0.52–0.67 and HR, 0.52, 95 percent CI, 0.44–0.61, respectively) vs oGLD use.
The findings suggest that the incidence of HF in diabetic patients could be reduced with SGLT-2i use, said Cavender. “[Our] results go one step further to show that SGLT-2 inhibition may benefit all patients with diabetes, regardless of whether they have known [CVD].”
These findings were consistent with the full results of the CVD-REAL study, which showed a reduced risk of death (HR, 0.49; p<0.001) and hospitalization for HF (HR, 0.61; p<0.001) with SGLT-2i vs oGLD. [Circulation 2017;doi:10.1161/CIRCULATIONAHA.117.029190]
However, as SGLT-2i is a relatively new class, longer follow-ups are warranted to evaluate its effects over time, noted the researchers.
Overall, this study has important clinical implications and underlines the need for new treatment alternatives for T2D since it is a major CVD risk factor. [Lancet 2010;375:2215-2222; Circulation 2008;117:2544-2565] Together with other ongoing randomized trials, the findings provide further evidence regarding the potential role of SGLT-2i in T2D management, said Cavender. “[These data may] help establish the real-world effectiveness of treatments in a broad population of patients from clinical practice.”