SGLT2 Inhibitors May Have Clinical Benefits For Patients with Diabetes After Myocardial Infarction | ASHP Midyear
Research found that SGLT2 inhibitors were associated with a lower risk of major cardiovascular events or hospitalization for heart failure.
Sodium-glucose cotransporter-2 (SGLT2) inhibitors were associated with a lower risk of major cardiovascular events or hospitalization for heart failure in patients with diabetes following myocardial infarction, according to recent research data presented at the American Society of Health-System Pharmacists 2024 Midyear Clinical Meeting and Exhibition, held December 8 to 12 in New Orleans, Louisiana.1
SGLT2 Inhibitors May Have Clinical Benefits For Patients with Diabetes After Myocardial Infarction | ASHP Midyear / Chinnapong - stock.adobe.com
SGLT2 inhibitors are a class of oral anti-hyperglycemic agents for the treatment of diabetes. The medications have a unique mechanism of action and lower glucose independent of insulin. Research has shown that SGLT2 inhibitors have many benefits aside from their glucose lowering effect, including weight loss, blood pressure reduction, improvements in low-density lipoprotein and high-density lipoprotein, and can significantly reduce the risk of death from cardiovascular causes.2
READ MORE: Assessing Improvements to Reduce Insulin-Related Hypoglycemic Events | ASHP Midyear
“The 2022 Annual Report on Causes of Death in Taiwan highlights an increase in non-hypertensive cardiac disease fatalities,” the authors wrote. “Emerging anti-diabetes drugs, such as GLP-1 receptor agonists (GLP-1s) and SGLT2 inhibitors, show cardiovascular benefits, but their roles post-myocardial infarction are not well-defined in current guidelines.”
Investigators from the Taiwan Society of Health System Pharmacists conducted a study to evaluate the efficacy of SGLT2 inhibitors, GLP-1s, and DPP-4 (DPP4) inhibitors in reducing major cardiovascular events and heart failure hospitalizations in diabetic patients post-myocardial infarction. Data for the study was gathered from the National Health Insurance Research Database between January 2015 and December 2021.
The study cohort included patients with diabetes who had been treated in emergency departments for myocardial infarction between 2016 and 2020. The study conducted 3 analyses: 2973 patients who took SGLT2 inhibitors and 185 patients who took GLP-1s in analysis 1; 2365 patients who took SGLT2 inhibitors and an unknown number who took DPP4 inhibitors in analysis 2; and 173 patients who took GLP-1s and an unknown number who took DPP4 inhibitors in analysis 3.
The primary study outcome was a composite of myocardial infarction, stroke, cardiovascular death, and hospitalization for heart failure. Secondary outcomes included an individual analysis of each clinical event.
After adjusting for covariates, the study found that SGLT2 inhibitors were associated with a significantly lower risk of composite events compared to DPP4 inhibitors. The study also found that there were no significant differences between SGLT2 inhibitors compared to GLP-1s, or GLP-1s compared to DPP4 inhibitors. In the secondary analysis, SGLT2 inhibitors were associated with a significantly lower risk of myocardial infarction readmission, heart failure readmission, and cardiovascular death compared to DPP4 inhibitors.
In subgroup analyses based on the patient age, gender, whether they were new users, presence of heart failure, presence of chronic kidney disease, type of myocardial infarction, coronary intervention post-hospitalization, and type of SGLT2 inhibitors, the study showed that that the clinical benefits of SGLT2 inhibitors might interact with patients who have chronic kidney disease, are less than 65 years of age, or are undergoing percutaneous coronary intervention.
“Analysis found that clinical benefit may be due to the reduced risk of myocardial infarction, hospitalization for heart failure, and cardiovascular death,” the authors concluded. “However, there were no statistically significant differences observed when comparing SGLT2 inhibitors with GLP-1s or GLP-1s with DPP4i. This lack of significant findings may be attributed to the insufficient sample size for the GLP-1s. Future research utilizing larger databases is necessary to further investigate the cardioprotective effects of GLP-1RA.”
READ MORE: Diabetes Resource Center
Follow along with our coverage of the 2024 ASHP Midyear Clinical Meeting and Exhibition here.
