SGLT2 inhibitor effective against HF regardless of ejection fraction


Prof Gemma Figtree_USYD

Prof Gemma Figtree

Canagliflozin reduces the overall risk of heart failure (HF) events in patients with type 2 diabetes and high cardiovascular risk, irrespective of ejection fraction.

An Australian-led study, published in Circulation and presented at the American College of Cardiology meeting in New Orleans, found no clear difference in effects based on reduced (HFrEF) versus preserved (HFpEF) ejection fraction.

The findings extend the value of the CANVAS program of studies and ‘provide some hope for patients with diabetes and HFpEF, where no prior intervention has been shown to have clear clinical benefits’, the study said

It said that, as previously reported in the limbic, the CANVAS study of over 10,000 participants found canagliflozin reduced fatal or hospitalised HF events compared to placebo (Hazard Ratio 0.70)

By retrospectively determining the ejection fraction at the time of the admission for heart failure, the study calculated canagliflozin reduced events in the context of both HFrEF (HR 0.69) and HFpEF events (HR 0.83).

Ejection fraction could not be determined in some cases (HFuPF).

“In the sensitivity analysis where HFuEF events were assumed to be HFpEF, the updated HR for HFpEF events was 0.71 (95% CI 0.52-0.97) and if HFuEF events were assumed to be HFrEF events, the updated HR for HFrEF events was 0.64 (95% CI 0.48-0.86).”

“In summary, canagliflozin reduced the overall risk of HF events in patients with type 2 diabetes and high cardiovascular risk, with no clear difference in effects on HFrEF versus HFpEF events,” said the study authors led by Professor Gemma Figtree, an interventional cardiologist at Royal North Shore Hospital, Sydney.

“However, this study was limited by relying on EF measurements at the time of the event and not at baseline, and additional data from dedicated HFpEF trials are required.”

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