Abstract
BackgroundTo compare the cardiovascular event risk in type 2 diabetes patients newly receiving dapagliflozin vs. empagliflozin.MethodsWe conducted a retrospective cohort study by analyzing a multi-institutional electronic medical records database (Chang Gung Research Database) in Taiwan and included adult type 2 diabetes patients who were newly receiving sodium–glucose co-transporter 2 (SGLT2) inhibitors from 2016 to 2017. The primary outcome was a composite of cardiovascular death, myocardial infarction, ischemic stroke and heart failure. We followed up patients from initiation of SGLT2 inhibitors until the occurrence of cardiovascular events before December 31, 2018. We performed multivariable Cox proportional hazard modeling, adjusting for patients’ age, sex, laboratory data, co-morbidities, and concomitant medications.ResultsWe identified 12,681 new SGLT2 inhibitor users with a mean age of 58.9 (SD 11.8) years, of whom 43.9% were female and 45.8% were new dapagliflozin users. A total of 10,442 person-years of dapagliflozin use and 12,096 person-years of empagliflozin use were included. Compared to empagliflozin users, new users of dapagliflozin were found to have similar risks for primary composite outcome (adjusted HR: 0.91; 95% CI 0.73–1.14), cardiovascular death (adjusted HR: 0.54; 95% CI 0.14–2.12), myocardial infarction (adjusted HR: 0.77, 95% CI 0.49–1.19) and ischemic stroke (adjusted HR: 1.15; 95% CI 0.80–1.65), but a lower risk of heart failure (adjusted HR: 0.68; 95% CI 0.49–0.95).ConclusionThe risk of cardiovascular events was similar between dapagliflozin and empagliflozin new users, but dapagliflozin may have a better outcome in the reduction of heart failure in type 2 diabetes patients. Future prospective studies are required to confirm the findings.
Highlights
To compare the cardiovascular event risk in type 2 diabetes patients newly receiving dapagliflozin vs. empagliflozin
A meta-analysis of three large placebo-controlled cardiovascular outcome trials found that Sodium–glucose co-transporter 2 (SGLT2) inhibitors reduced major adverse cardiovascular events by 11% (HR: 0.89, 95% confidence intervals (CI) 0.83–0.96)
We found a similar risk of composite cardiovascular outcome, cardiovascular mortality, myocardial infarction and ischemic stroke between dapagliflozin and empagliflozin (Table 2)
Summary
To compare the cardiovascular event risk in type 2 diabetes patients newly receiving dapagliflozin vs. empagliflozin. Patients with type 2 diabetes suffer substantial morbidity and mortality from cardiovascular disease [1]. Current medication and lifestyle interventions may not be sufficient to reduce the risk of serious cardiovascular disease outcomes in the primary prevention cohorts of type 2 diabetes [2]. The largest absolute benefits of interventions for individual patients are achieved among those with established atherosclerotic cardiovascular disease, the large number of type 2 diabetes patients without a history of major cardiovascular disease makes knowledge about the effects of anti-diabetes medication on first events an additional priority [2]. A meta-analysis of three large placebo-controlled cardiovascular outcome trials found that SGLT2 inhibitors reduced major adverse cardiovascular events by 11% (HR: 0.89, 95% CI 0.83–0.96). The direct cardioprotective mechanisms are not fully understood, they may be related to hemodynamic and metabolic actions from SGLT2 inhibitors [7,8,9]
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