Latest CVD-REAL data bolster cardioprotective effects of SGLT2 inhibition
medwireNews: The CVD-REAL investigators have presented further results demonstrating the effects of sodium-glucose co-transporter (SGLT)2 inhibitors on cardiovascular outcomes in real-world clinical practice.
In three presentations given during a session on the failing heart at the EASD annual meeting in Lisbon, Portugal, investigators outlined the effects of pre-existing cardiovascular disease (CVD), and reported analyses of total heart failure (HF) events and of dapagliflozin compared with dipeptidyl peptidase (DPP)-4 inhibitors.
Matthew Cavender (University of North Carolina, Chapel Hill, USA) described the effects of pre-existing CVD in 153,078 SGLT2 inhibitor users who were matched by the propensity to be prescribed the medications to an equal number of patients using other antidiabetic medications.
He reported that, among patients with pre-existing CVD, the event rates per 100 patient–years in users versus nonusers of SGLT2 inhibitors were 1.4 versus 3.5 for all-cause mortality and 2.2 versus 3.4 for HF. After accounting for confounders, SGLT2 inhibitors were associated with significant relative risk reductions of 53% and 31%, respectively. Patients without CVD had much lower event rates, but there were still significant risk reductions with SGLT2 inhibitor use, of 66% and 55%, respectively.
An audience member argued that, although the relative risk reductions were large, the treatment would have a very small impact at a population level, because of the large proportion of patients without pre-existing CVD. Cavender agreed that the absolute effects would be larger in high-risk patients, but countered that greater overall benefits can be amassed by having a small effect on the risk of a very large number of people. “I would argue that this is, from a public health perspective, a much more important impact,” he said.
In the original CVD-REAL report, the team assessed time to first HF event, but in the second presentation, Mikhail Kosiborod (Saint Luke’s Mid America Heart Institute, Kansas City, USA) reported an analysis of all HF events, including recurrent ones. In fact, he called the findings “a lesson in epidemiology”, given that 967 HF events occurred in the 9007 patients with HF at baseline, compared with 584 in the 286,687 patients without prior HF.
Of the total HF events, 60.2% were first events and 39.8% recurrent. In line with the primary findings, the 149,297 patients taking an SGLT2 inhibitor were 45% less likely to have an event than the equal number of propensity-matched patients taking other glucose-lowering medications.
The final analysis, using data from the three Nordic countries included in CVD-REAL, concerned the risk for major adverse cardiovascular events (MACE) in 10,227 new users of dapagliflozin versus 30,681 propensity-matched new users of DPP-4 inhibitors.
Anna Norhammar (Karolinska University Hospital, Stockholm, Sweden) reported that patients given dapagliflozin (which accounts for the vast majority of SGLT2 prescriptions in the countries concerned) had a significantly reduced risk for MACE relative to DPP-4 users, which becamee apparent within the first year after they starting taking the medication.
The risk was reduced by 21% for MACE, by 19% for MACE plus unstable angina, and by 25% for MACE plus unstable angina and HF.
By Eleanor McDermid
medwireNews is an independent medical news service provided by Springer Healthcare. © 2017 Springer Healthcare part of the Springer Nature group