Abstract
BackgroundEvidence from prospective cardiovascular (CV) outcome trials in type 2 diabetes (T2DM) patients supports the use of sodium–glucose co-transporter-2 inhibitors (SGLT2i) to reduce the risk of CV events. In this study, we compared the risk of several CV outcomes between new users of SGLT2i and other glucose-lowering drugs (oGLDs) in Catalonia, Spain.MethodsCVD-REAL Catalonia was a retrospective cohort study using real-world data routinely collected between 2013 and 2016. The cohorts of new users of SGLT2i and oGLDs were matched by propensity score on a 1:1 ratio. We compared the incidence rates and hazard ratio (HR) for all-cause death, hospitalization for heart failure, chronic kidney disease, and modified major adverse CV event (MACE; all-cause mortality, myocardial infarction, or stroke).ResultsAfter propensity score matching, 12,917 new users were included in each group. About 27% of users had a previous history of CV disease. In the SGLT2i group, the exposure time was 60% for dapagliflozin, 26% for empagliflozin and 14% for canagliflozin. The use of SGLT2i was associated with a lower risk of heart failure (HR: 0.59; 95% confidence interval [CI] 0.47–0.74; p < 0.001), all-cause death (HR = 0.41; 95% CI 0.31–0.54; p < 0.001), all-cause death or heart failure (HR = 0.55; 95% CI 0.47–0.63; p < 0.001), modified MACE (HR = 0.62; 95% CI 0.52–0.74; p < 0.001), and chronic kidney disease (HR = 0.66; 95% CI 0.54–0.80; p < 0.001).ConclusionsIn this large, retrospective observational study of patients with T2DM from a Catalonia, initiation of SGLT-2i was associated with lower risk of mortality, as well as heart failure and CKD.
Highlights
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality among individuals with type 2 diabetes mellitus (T2DM) [1, 2]
Treatment initiation was associated with a lower risk of nonfatal myocardial infarction (MI), nonfatal stroke or CV death, and allcause mortality compared with dipeptidyl peptidase-4 inhibitors (DPP-4i) [21]
A total of 239,733 subjects with T2DM were identified as new user episodes of glucose-lowering drugs during the observational period in the SIDIAP database, with 226,452 of them (94.5%) initiating treatment with and the remaining 13,281 with an sodium–glucose co-transporter-2 inhibitors (SGLT2i) (5.5%)
Summary
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality among individuals with type 2 diabetes mellitus (T2DM) [1, 2]. The results of the CVD-REAL 1 and 2 studies showed that the use of SGLT2i was associated with decreased risk of hospitalisation for HF and allcause mortality in subjects with a broad range of CV risk [18, 19]. The CVD-REAL Nordic (conducted in Denmark, Norway, and Sweden) reported an association between SGLT2i initiation and a decreased risk of CV mortality and MACE compared with oGLDs [20]. The results from the CVD-REAL 2 Study (conducted in Asia Pacific, the Middle East, North America and Spain) confirmed that the use of SGLT2i was associated with a lower risk of death, death or hospitalisation for HF, MI, and stroke in a broad range of T2DM subjects with or without CVD [19]. We compared the risk of several CV outcomes between new users of SGLT2i and other glucose-lowering drugs (oGLDs) in Catalonia, Spain
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