Letter by Jin-shan and Xue-bin Regarding Article, "Lower Risk of Heart Failure and Death in Patients Initiated on Sodium-Glucose Cotransporter-2 Inhibitors Versus Other Glucose-Lowering Drugs: The CVD-REAL Study (Comparative Effectiveness of Cardiovascular Outcomes in New Users of Sodium-Glucose Cotransporter-2 Inhibitors)".

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HomeCirculationVol. 137, No. 9Letter by Jin-shan and Xue-bin Regarding Article, “Lower Risk of Heart Failure and Death in Patients Initiated on Sodium-Glucose Cotransporter-2 Inhibitors Versus Other Glucose-Lowering Drugs: The CVD-REAL Study (Comparative Effectiveness of Cardiovascular Outcomes in New Users of Sodium-Glucose Cotransporter-2 Inhibitors)” Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBLetter by Jin-shan and Xue-bin Regarding Article, “Lower Risk of Heart Failure and Death in Patients Initiated on Sodium-Glucose Cotransporter-2 Inhibitors Versus Other Glucose-Lowering Drugs: The CVD-REAL Study (Comparative Effectiveness of Cardiovascular Outcomes in New Users of Sodium-Glucose Cotransporter-2 Inhibitors)” He Jin-shan, MD and Li Xue-bin, MD He Jin-shanHe Jin-shan Department of Cardiology, Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Peking University People’s Hospital, Beijing, China. Search for more papers by this author and Li Xue-binLi Xue-bin Department of Cardiology, Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Peking University People’s Hospital, Beijing, China. Search for more papers by this author Originally published27 Feb 2018https://doi.org/10.1161/CIRCULATIONAHA.117.031407Circulation. 2018;137:988To the Editor:We read with great interest the article by Kosiborod and colleagues1 about the lower risk of heart failure and death in patients initiated on sodium-glucose cotransporter-2 inhibitors(SGLT-2i) versus other glucose-loweringinhibitors (SGLT-2i) versus other glucose-lowering drugs. This large real-world study of >300 000 patients with type 2 diabetes mellitus shows obvious heart failure and all-cause death in patients treated with SGLT-2i, and there is no significant heterogeneity across countries despite geographic variations in the use of specific SGLT-2i. This study may change our management of patients with diabetes mellitus.We have several questions about this study. First, what is the mechanism of SGLT-2i’s cardiovascular benefits? Better glucose control or a nonglycemic reason? SGLT-2i can inhibit the absorption of glucose and sodium in the kidneys, it will have some diuretic effect and relieve the symptoms of heart failure, but can it lower the risk of myocardial infarction in diabetes mellitus? Second, in this study, ≈87% of patients do not have known cardiovascular disease, suggesting possible cardiovascular benefits for a broad population of patients with type 2 diabetes mellitus. Will patients both with and without cardiovascular disease benefit from SGLT-2i? Which ones benefit more? Will patients with severe cardiovascular disease such as myocardial infarction still benefit from it? Third, efficacy and safety are quite important for glucose-lowering drugs. What about the glucose control of SGLT-2i compared with other drugs? What about the rate of hypoglycemia? We are looking forward to using it effectively and safely in clinical practice.DisclosuresNone.Footnoteshttp://circ.ahajournals.orgReference1. Kosiborod M, Cavender MA, Fu AZ, Wilding JP, Khunti K, Holl RW, Norhammar A, Birkeland KI, Jørgensen ME, Thuresson M, Arya N, Bodegård J, Hammar N, Fenici P; CVD-REAL Investigators and Study Group. Lower risk of heart failure and death in patients initiated on sodium-glucose cotransporter-2 inhibitors versus other glucose-lowering drugs: the CVD-REAL study (Comparative Effectiveness of Cardiovascular Outcomes in New Users of Sodium-Glucose Cotransporter-2 Inhibitors).Circulation. 2017; 136:249–259. doi: 10.1161/CIRCULATIONAHA.117.029190.LinkGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetails February 27, 2018Vol 137, Issue 9 Advertisement Article InformationMetrics © 2018 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.117.031407PMID: 29483179 Originally publishedFebruary 27, 2018 PDF download Advertisement SubjectsDiabetes, Type 2Heart Failure