Cardiovascular benefits in patients with type 2 diabetes from the use of sodium-glucose cotransporter 2 (SGLT-2) inhibitors extend to all patient subgroups, according to results of a large meta-analysis published in the Journal of the American Heart Association.
The researchers included four large-scale clinical trials in the analysis. Each study looked at patients with diabetes mellitus and that reported overall cardiovascular outcomes (and for studies that defined patient subgroups by cardiovascular disease, kidney function, and heart failure). The total patient population between the included studies consisted of 38,723 patients with type 2 diabetes and treated with either canagliflozin, empagliflozin, and/or dapagliflozin. The authors used fixed effects models with inverse variance weighting to estimate summary hazard ratios (all confidence intervals were 95%).
Benefits Across All Subgroups
According to the results, there were 3,828 major adverse cardiac events reported. In the studies, 22,870 (59%) had cardiovascular disease, 7,754 (20%) had reduced kidney function, and 4,543 (12%) had heart failure. The overall reported benefit (expressed via hazard ratio) for major adverse cardiac events was 0.88; 95% CI, 0.83 to 0.94; P<0.001). There was no evidence that the effects of the SGLT-2 inhibitor effect varied cross patient subgroups, and all patient subgroups showed some benefit with respect to hospitalization for heart failure, cardiovascular death, and any-cause mortality. Stroke showed a slight difference in the subgroups, with a protective effect observed in patients with reduced kidney function, but not in those with preserved kidney function.
“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,” said Dr. Clare Arnott, lead study author and 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.”