The cardiovascular benefits of SGLT2 inhibitors seen in randomised controlled trials are also evident in real world practice, according to an observational study that involved more than 200,000 Australian patients with type 2 diabetes.

And results from the multinational study also suggest that the cardiovascular benefits apply in lower risk patients and not just those with pre-existing cardiovascular disease, according to study co-author Professor Jonathan Shaw of the Baker Heart and Diabetes institute, Melbourne.

Presenting the findings at the Australian Diabetes Congress in Adelaide, Professor Shaw described how the CVD-Real 2 study used registry data to compare the outcomes of SGLT2 inhibitor treatment with other blood glucose lowering drugs in over 470,000 patients with type 2 diabetes.

Dapagliflozin was the most commonly used SGLT2 inhibitor (75%) followed by empagliflozin (9%), while other SGLT2 inhibitors accounted for 16%.

Compared to other glucose lowering drugs, patients who were started on a SGLT2 inhibitor had a 36% lower risk of hospitalisation for heart failure (Hazard Ratio 0.64).

There was also a significantly lower risk of death (HR: 0.51). Risks of MI and stroke were also modestly and significantly lower inpatients on SGLT2 inhibitors compared to other glucose lowering drugs

“CVD REAL 2 shows that the [cardiovascular and mortality] benefits of SGLT2 inhibitors in clinical practice are the same as seen in randomised clinical trials,” said Professor Shaw.

Speaking to the limbic, he said the benefits of SGLT2 inhibitors seemed to be a class effect, but did not appear to be dose related.

And while not all confounding factors could be accounted for in the CVD REAL 2 study, it appeared the cardiovascular benefits of SGLT2 inhibitors extended to primary prevention in patients without pre-existing cardiovascular disease.

It was not clear what the mechanism behind the improved cardiovascular outcomes was, but it seemed to be in addition to the beneficial effects of SGLT2 inhibitors on weight loss, blood pressure and blood glucose,  Professor Shaw noted.

Some researchers had speculated the cardiovascular benefit may be due to removal of fluid, while others had suggested the drugs may work by making cardiac tissue more fuel efficient in use of energy and therefore more resilient to stress.

“With the evidence we have from clinical trials and now from real world practice, if you have a patient with diabetes and cardiovascular risk we need to be asking why they are not on them [SGLT2 inhibitors],” he said.

The CVD-REAL study was sponsored by AstraZeneca, makers of dapagliflozin.