CVD-REAL extends EMPA-REG findings to real-world patients
medwireNews: Findings from the CVD-REAL trial show a protective effect of sodium glucose cotransporter-2 (SGLT-2) inhibitors against heart failure (HF) in real-world patients with type 2 diabetes.
Among 309,046 patients from six countries, use of an SGLT-2 inhibitor reduced the risk for HF hospitalization by 39% and for all-cause mortality by 51%, the researchers reported at the 2017 American College of Cardiology conference in Washington, DC, USA.
Half of the patients were taking an SGLT-2 inhibitor, and each was matched by a score for the propensity to initiate an SGLT-2 inhibitor to a patient who was taking other antidiabetic agents.
The findings build on those of the EMPA-REG study, which showed a reduced risk for cardiovascular events among high-risk diabetes patients taking empagliflozin versus those taking placebo. The CVD-REAL patients were drawn from primary care and hospital records, medical claims and electronic health records, and national registers, so represented real-world patients with a broader range of vascular risk.
Indeed, 87% of the patients were free of known cardiovascular disease at the time of first SGLT-2 prescription, suggesting that SGLT-2 inhibition may benefit even diabetes patients with relatively low vascular risk.
The CVD-REAL findings suggest a class effect of SGLT-2 inhibitors, rather than the cardioprotective effects being limited to empagliflozin. The patients came from six countries – Germany, Norway, Denmark, Sweden, the UK, and the USA – but the reduced HF risk for those taking SGLT-2 inhibitors was consistent among patients from all countries involved.
Speaking to medwireNews, study co-investigator and Medicine Matters diabetes editorial board member John Wilding (University of Liverpool, UK) described it as “remarkable” that the study showed such consistent results “between countries with very different healthcare systems, and different patients, with different patterns of SGLT-2 inhibitor use – mostly canagliflozin in USA; mostly dapagliflozin in Europe.”
In the USA, 75.9% of patients taking an SGLT-2 inhibitor were taking canagliflozin, with 19.0% taking dapagliflozin and 5.1% empagliflozin. In the European countries, by contrast, 91.9% of patients were taking dapagliflozin, 6.3% empagliflozin, and just 1.8% canagliflozin.
This underlines the generalizability of the findings, Wilding noted. “The importance of these real-world observations is complementary to clinical trials, and as a clinician gives me greater confidence when deciding to use an SGLT-2 inhibitor in clinical practice.”
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