Medicines

SGLT-2 inhibitors offer more short term cardioprotective benefit compared to DPP-4 inhibitors


People with type 2 diabetes who use SGLT2 inhibitors have a lower risk of major adverse cardiovascular events (MACE) compared with people who use DPP-4 inhibitors a major observational study has found.

Published in the BMJ, the Canadian retrospective study compared outcomes after almost one year of follow up for more than 200,000 patients taking SGLT2 inhibitors and a similar matched number of patients taking DPP-4 inhibitors. The data were derived from new adult users of the drugs based on healthcare databases from several Canadian provinces and the UK Clinical Practice Research Datalink (CPRD).

SGLT2 inhibitor use was associated with a significant 24% lower risk of the composite outcome of myocardial infarction, ischaemic stroke, or cardiovascular death (incidence rate per 1000 person years: 11.4 v 16.5; hazard ratio 0.76).

The independent analysis, conducted by the Canadian Network for Observational Drug Effect Studies (CNODES) Investigators, also found decreased risks for individual outcomes such as myocardial infarction (5.1 v 6.4/1000 person years; HR 0.82), cardiovascular death (3.9 v 7.7; HR 0.60), heart failure (3.1 v 7.7; HR 0.43), and all-cause mortality (8.7 v 17.3; HR 0.60) with SGLT2 inhibitor use compared to DPP-4 inhibitor use.

SGLT2 inhibitors had more modest benefits for ischaemic stroke (2.6 v 3.5; HR 0.85).

The reduction in MACE was similar across all the SGLT2 inhibitors in the study: canagliflozin (HR 0.79) dapagliflozin (0.73) and empagliflozin (0.77).

The findings were also generally consistent across patient subgroups defined by age, sex, past insulin use, and history of cardiovascular disease or history of heart failure.

The study investigators said there was good evidence from randomised controlled trials that SGLT2 inhibitors were better than placebo at reducing cardiovascular events, but they had not been compared with other second line to third line antidiabetic treatments.

It was also not know if the benefits seen in RCT extended to real world populations, they added.

“These findings suggest that SGLT2 inhibitors offer cardioprotective benefits among people with type 2 diabetes in a real world setting, although additional studies are needed to determine if these benefits persist long term,” they concluded.

The study was funded by the Canadian Institutes of Health Research.

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