SGLT-2 Inhibitors and Cardiovascular Risk: An Analysis of CVD-REAL

CVD-REAL Investigators and Study Group

doi:10.1016/j.jacc.2018.01.085

SGLT-2 Inhibitors and Cardiovascular Risk: An Analysis of CVD-REAL

CVD-REAL Investigators and Study Group

Steno Diabetes Center Copenhagen

113 Citationer (Scopus)

Abstract

BACKGROUND: Prior studies found patients treated with sodium-glucose co-transporter-2 inhibitors (SGLT-2i) had lower rates of death and heart failure (HF). Whether the benefits of SGLT-2i vary based upon the presence of cardiovascular disease (CVD) is unknown.

OBJECTIVES: This study sought to determine the association between initiation of SGLT-2i therapy and HF or death in patients with and without CVD.

METHODS: The CVD-REAL (Comparative Effectiveness of Cardiovascular Outcomes in New Users of SGLT-2 Inhibitors) study was a multinational, observational study in which adults with type 2 diabetes were identified. Patients prescribed an SGLT-2i or other glucose-lowering drugs (GLDs) were matched based on a propensity score for initiation of an SGLT-2i. Hazard ratios (HRs) for the risk of death, HF, and HF or death in patients with and without established CVD were estimated for each country and pooled.

RESULTS: After propensity score matching, 153,078 patients were included in each group. At baseline, 13% had established CVD. Compared with therapy using other GLDs, initiation of an SGLT-2i was associated with lower risk of death in patients with and without CVD (HR: 0.56; 95% confidence interval [CI]: 0.44 to 0.70; and HR: 0.56; 95% CI: 0.50 to 0.63, respectively). There were also associations between SGLT-2i and lower risk of HF (HR: 0.72; 95% CI: 0.63 to 0.82; and HR: 0.61; 95% CI: 0.48 to 0.78, respectively) and the composite of HF or death (HR: 0.63; 95% CI: 0.57 to 0.70; and HR: 0.56; 95% CI: 0.50 to 0.62, respectively) observed in patients with and without established CVD.

CONCLUSIONS: In this large, multinational, observational study, initiation of SGLT-2i was associated with lower risk of death and HF regardless of pre-existing CVD. Ongoing clinical trials will provide further evidence regarding the benefit of SGLT-2i in patients without established CVD. (Comparative Effectiveness of Cardiovascular Outcomes in New Users of SGLT-2 Inhibitors [CVD-REAL]; NCT02993614).

Originalsprog	Engelsk
Tidsskrift	Journal of the American College of Cardiology
Vol/bind	71
Udgave nummer	22
Sider (fra-til)	2497-2506
Antal sider	10
ISSN	0735-1097
DOI	https://doi.org/10.1016/j.jacc.2018.01.085
Status	Udgivet - 5 jun. 2018

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10.1016/j.jacc.2018.01.085

Citationsformater

@article{887c105cc14d48f58d051a6ac8a81193,

title = "SGLT-2 Inhibitors and Cardiovascular Risk: An Analysis of CVD-REAL",

abstract = "BACKGROUND: Prior studies found patients treated with sodium-glucose co-transporter-2 inhibitors (SGLT-2i) had lower rates of death and heart failure (HF). Whether the benefits of SGLT-2i vary based upon the presence of cardiovascular disease (CVD) is unknown.OBJECTIVES: This study sought to determine the association between initiation of SGLT-2i therapy and HF or death in patients with and without CVD.METHODS: The CVD-REAL (Comparative Effectiveness of Cardiovascular Outcomes in New Users of SGLT-2 Inhibitors) study was a multinational, observational study in which adults with type 2 diabetes were identified. Patients prescribed an SGLT-2i or other glucose-lowering drugs (GLDs) were matched based on a propensity score for initiation of an SGLT-2i. Hazard ratios (HRs) for the risk of death, HF, and HF or death in patients with and without established CVD were estimated for each country and pooled.RESULTS: After propensity score matching, 153,078 patients were included in each group. At baseline, 13% had established CVD. Compared with therapy using other GLDs, initiation of an SGLT-2i was associated with lower risk of death in patients with and without CVD (HR: 0.56; 95% confidence interval [CI]: 0.44 to 0.70; and HR: 0.56; 95% CI: 0.50 to 0.63, respectively). There were also associations between SGLT-2i and lower risk of HF (HR: 0.72; 95% CI: 0.63 to 0.82; and HR: 0.61; 95% CI: 0.48 to 0.78, respectively) and the composite of HF or death (HR: 0.63; 95% CI: 0.57 to 0.70; and HR: 0.56; 95% CI: 0.50 to 0.62, respectively) observed in patients with and without established CVD.CONCLUSIONS: In this large, multinational, observational study, initiation of SGLT-2i was associated with lower risk of death and HF regardless of pre-existing CVD. Ongoing clinical trials will provide further evidence regarding the benefit of SGLT-2i in patients without established CVD. (Comparative Effectiveness of Cardiovascular Outcomes in New Users of SGLT-2 Inhibitors [CVD-REAL]; NCT02993614).",

author = "Cavender, {Matthew A} and Anna Norhammar and Birkeland, {K{\aa}re I} and J{\o}rgensen, {Marit Eika} and Wilding, {John P} and Kamlesh Khunti and Fu, {Alex Z} and Johan Bodeg{\aa}rd and Blak, {Betina T} and Eric Wittbrodt and Marcus Thuresson and Peter Fenici and Niklas Hammar and Mikhail Kosiborod and {CVD-REAL Investigators and Study Group}",

year = "2018",

month = jun,

day = "5",

doi = "10.1016/j.jacc.2018.01.085",

language = "English",

volume = "71",

pages = "2497--2506",

journal = "Journal of the American College of Cardiology",

issn = "0735-1097",

publisher = "Elsevier Inc.",

number = "22",

}

TY - JOUR

T1 - SGLT-2 Inhibitors and Cardiovascular Risk

T2 - An Analysis of CVD-REAL

AU - Cavender, Matthew A

AU - Norhammar, Anna

AU - Birkeland, Kåre I

AU - Jørgensen, Marit Eika

AU - Wilding, John P

AU - Khunti, Kamlesh

AU - Fu, Alex Z

AU - Bodegård, Johan

AU - Blak, Betina T

AU - Wittbrodt, Eric

AU - Thuresson, Marcus

AU - Fenici, Peter

AU - Hammar, Niklas

AU - Kosiborod, Mikhail

AU - CVD-REAL Investigators and Study Group

PY - 2018/6/5

Y1 - 2018/6/5

N2 - BACKGROUND: Prior studies found patients treated with sodium-glucose co-transporter-2 inhibitors (SGLT-2i) had lower rates of death and heart failure (HF). Whether the benefits of SGLT-2i vary based upon the presence of cardiovascular disease (CVD) is unknown.OBJECTIVES: This study sought to determine the association between initiation of SGLT-2i therapy and HF or death in patients with and without CVD.METHODS: The CVD-REAL (Comparative Effectiveness of Cardiovascular Outcomes in New Users of SGLT-2 Inhibitors) study was a multinational, observational study in which adults with type 2 diabetes were identified. Patients prescribed an SGLT-2i or other glucose-lowering drugs (GLDs) were matched based on a propensity score for initiation of an SGLT-2i. Hazard ratios (HRs) for the risk of death, HF, and HF or death in patients with and without established CVD were estimated for each country and pooled.RESULTS: After propensity score matching, 153,078 patients were included in each group. At baseline, 13% had established CVD. Compared with therapy using other GLDs, initiation of an SGLT-2i was associated with lower risk of death in patients with and without CVD (HR: 0.56; 95% confidence interval [CI]: 0.44 to 0.70; and HR: 0.56; 95% CI: 0.50 to 0.63, respectively). There were also associations between SGLT-2i and lower risk of HF (HR: 0.72; 95% CI: 0.63 to 0.82; and HR: 0.61; 95% CI: 0.48 to 0.78, respectively) and the composite of HF or death (HR: 0.63; 95% CI: 0.57 to 0.70; and HR: 0.56; 95% CI: 0.50 to 0.62, respectively) observed in patients with and without established CVD.CONCLUSIONS: In this large, multinational, observational study, initiation of SGLT-2i was associated with lower risk of death and HF regardless of pre-existing CVD. Ongoing clinical trials will provide further evidence regarding the benefit of SGLT-2i in patients without established CVD. (Comparative Effectiveness of Cardiovascular Outcomes in New Users of SGLT-2 Inhibitors [CVD-REAL]; NCT02993614).

AB - BACKGROUND: Prior studies found patients treated with sodium-glucose co-transporter-2 inhibitors (SGLT-2i) had lower rates of death and heart failure (HF). Whether the benefits of SGLT-2i vary based upon the presence of cardiovascular disease (CVD) is unknown.OBJECTIVES: This study sought to determine the association between initiation of SGLT-2i therapy and HF or death in patients with and without CVD.METHODS: The CVD-REAL (Comparative Effectiveness of Cardiovascular Outcomes in New Users of SGLT-2 Inhibitors) study was a multinational, observational study in which adults with type 2 diabetes were identified. Patients prescribed an SGLT-2i or other glucose-lowering drugs (GLDs) were matched based on a propensity score for initiation of an SGLT-2i. Hazard ratios (HRs) for the risk of death, HF, and HF or death in patients with and without established CVD were estimated for each country and pooled.RESULTS: After propensity score matching, 153,078 patients were included in each group. At baseline, 13% had established CVD. Compared with therapy using other GLDs, initiation of an SGLT-2i was associated with lower risk of death in patients with and without CVD (HR: 0.56; 95% confidence interval [CI]: 0.44 to 0.70; and HR: 0.56; 95% CI: 0.50 to 0.63, respectively). There were also associations between SGLT-2i and lower risk of HF (HR: 0.72; 95% CI: 0.63 to 0.82; and HR: 0.61; 95% CI: 0.48 to 0.78, respectively) and the composite of HF or death (HR: 0.63; 95% CI: 0.57 to 0.70; and HR: 0.56; 95% CI: 0.50 to 0.62, respectively) observed in patients with and without established CVD.CONCLUSIONS: In this large, multinational, observational study, initiation of SGLT-2i was associated with lower risk of death and HF regardless of pre-existing CVD. Ongoing clinical trials will provide further evidence regarding the benefit of SGLT-2i in patients without established CVD. (Comparative Effectiveness of Cardiovascular Outcomes in New Users of SGLT-2 Inhibitors [CVD-REAL]; NCT02993614).

U2 - 10.1016/j.jacc.2018.01.085

DO - 10.1016/j.jacc.2018.01.085

M3 - Journal article

C2 - 29852973

SN - 0735-1097

VL - 71

SP - 2497

EP - 2506

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

IS - 22

ER -

SGLT-2 Inhibitors and Cardiovascular Risk: An Analysis of CVD-REAL

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