SGLT2 Inhibitors Show CV Benefit in All Patients with Type 2 Diabetes

A large multi-study review found that sodium-glucose cotransporter 2 (SGLT2) inhibitors are likely to provide protective effects from cardiovascular (CV) events in patients with type 2 diabetes, regardless of established CV disease (CVD).

Previous studies have underscored the benefit of SGLT2 inhibitors in those with type 2 diabetes and CVD, but whether that protective effect extended across other patient subsets had been unclear.

In the review and meta-analysis, which was published in the Journal of the American Heart Association, the researchers pooled data from 4 clinical trials to evaluate the CV benefits and the effects on key safety outcomes of SGLT2 inhibition in both patients with and without established CVD, reduced kidney function, or heart failure (HF).

Overall, the studies included 38,723 patients with type 2 diabetes and assessed 3 SGLT2 inhibitors: canagliflozin, empagliflozin, and dapagliflozin.

Of the patients, 59% had CVD, 20% had reduced kidney function, and 12% had HF. There were 3828 major adverse cardiac event (MACE) outcomes, 1192 hospitalizations for HF, 1506 CV deaths, and 2612 deaths from any cause.

All patient subgroups benefited from SGLT2 inhibition.

Overall, the results showed:

• A 12% overall proportional reduction in MACE

• A 17% relative reduction in CV death

• Consistent CV benefits regardless of baseline history of CV disease, HF, or reduced kidney function

• A possible reduction in stroke events in those with reduced kidney function.

The authors noted that the magnitude of protection achieved may vary across patients, but the available evidence does not identify a patient group that is unlikely to achieve significant CV protection from use of SGLT2 inhibitors.

Based on these findings, the study authors wrote, “Our results call for a reevaluation of current guideline recommendations for SGLT2 inhibitor therapy, with a view to include those with and without established CVD.”

“In this meta-analysis of large event-driven SGLT2 inhibitor outcome trials we found SGLT2 inhibitors protected against cardiovascular disease and death in diverse subsets of patients with type 2 diabetes regardless of their cardiovascular disease history,” lead author Dr Clare Arnott, Senior Research Fellow at the George Institute for Global Health, said in a press release.

“While the extent of this protective effect may vary across patient types, the consistency of the findings suggests significant and broad cardiovascular protection can be achieved from use of this drug class.”

References:

• Arnott C, Li Q, Kang A, et al. Sodium-glucose cotransporter 2 inhibition for the prevention of cardiovascular events in patients with type 2 diabetes mellitus: A systematic review and meta-analysis. Journal of the American Heart Association. 2020. Doi: https://doi.org/10.1161/JAHA.119.014908

• Study finds drug class provides cardiovascular benefit for all patients with type 2 diabetes [news release]. The George Institute for Global Health’s website. https://www.georgeinstitute.org/media-releases/study-finds-drug-class-provides-cardiovascular-benefit-for-all-patients-with-type-2. Accessed January 31, 2020.