Use of SGLT2i Show Greater Risk Reduction in Patients with Type 2 Diabetes, CVD

Elisabetta Patorno, MD

Previous trial data has shown cardiovascular benefits of both sodium-glucose cotransporter-2 (SGLT2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in patients with type 2 diabetes (T2D), with established cardiovascular disease (CVD).

In a recent study, a team of investigators, led by Elisabetta Patorno, MD, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, aimed to evaluate if SGLT2 inhibitors and GLP-1 RAs have associations with cardiovascular benefit among patients with T2D, with and without CVD.

They observed that the use of SGLT2 inhibitors showed consistent reduction in hospitalization for heart failure risk in the patient population with and without CVD, noting a greater absolute benefit in patients with CVD.

Methods

The population-based cohort study identified data in Medicare and US commercial claims data sets from April 2013 - December 2017.

Participants in the study included 1:1 propensity-score matched adult patients with T2D, with and without CVD. A total of 52,901 and 133,139 matched pairs were identified for patients with and without CVD, respectively. Each patient initiated SGLT2 inhibitor therapy or GLP-1 RA therapy.

Investigators identified the primary outcomes as myocardial infarction (MI) or stroke hospitalization and hospitalization for heart failure (HHF). In statistical analysis, the team estimated pooled hazard ratios (HR) and rate differences (RD) per 1000-person years, with 95% confidence intervals.

Findings

Results from the study demonstrated that the initiation of SGLT2 inhibitor therapy, in comparison to GLP-1 RA therapy, was associated with slightly lower risk for myocardial infarction (MI) or stroke in patients with CVD (HR, 0.90, 95% CI, 0.82 to 0.98; RD, −2.47, 95% CI, −4.45 to −0.50).

However, a similar risk was seen in patients with T2D without CVD (HR, 1.07, 95% CI, 0.97 to 1.18]; RD, 0.38, 95% CI, −0.30 to 1.07).

Additionally, the initiation of SGLT2 inhibitor therapy versus GLP-1 RA therapy was associated with a reduction in HHF risk, regardless of baseline CVD in patients with CVD (HR, 0.71, 95% CI, 0.64 to 0.79; RD, −4.97, 95% CI, −6.55 to −3.39).

A similar reduction was seen in patients  without CVD (HR, 0.69, 95% CI, 0.56 to 0.85; RD, −0.58, 95% CI, −0.91 to −0.25).

Takeaways

The team concluded that the use of SGLT2 inhibitors showed consistent reduction in HHF risk in the patient population with T2D, with and without CVD. However, they noted a greater absolute benefit in patients with CVD.

“There were no large differences in risk for MI or stroke among T2D patients with and without CVD,” investigators wrote.

The study, “Sodium–Glucose Cotransporter-2 Inhibitors Versus Glucagon-like Peptide-1 Receptor Agonists and the Risk for Cardiovascular Outcomes in Routine Care Patients With Diabetes Across Categories of Cardiovascular Disease,” was published in Annals of Internal Medicine.