By Nicole MacKee
Sodium-glucose cotransporter-2 (SGLT2) inhibitors protect against cardiovascular (CV) events in patients with type 2 diabetes, regardless of their history of CVD, researchers have reported in the Journal of the American Heart Association.
The researchers, led by Dr Clare Arnott at the George Institute for Global Health, Sydney, completed a systematic review and meta-analysis of four trials of SGLT2 inhibitors in patients with type 2 diabetes, in which three SGLT2 inhibitors were evaluated (canagliflozin, empagliflozin and dapagliflozin). The trials included 38,723 participants, of whom 22,870 (59%) had CV disease, 7754 (20%) had reduced kidney function and 4543 (12%) had heart failure.
The researchers found an overall 12% reduction in major adverse CV events in patients taking SGLT2 inhibitors, compared with those taking placebo. Relative reductions in CV death (17%) and hospitalisations for heart failure (32%) were also found, but no overall effect on stroke risk.
The researchers reported that the cardioprotective effects were consistent across patient groups irrespective of CVD history, heart failure or reduced kidney function. Professor Jenny Gunton, Head of the University of Sydney’s Centre for Diabetes, Obesity and Endocrinology Research, said most SGLT2 inhibitors appeared to be cardioprotective and, so far, all improved heart failure.
‘Dapagliflozin did not show any other cardiovascular benefit, however, and I would not select it for a person with preexisting cardiovascular disease or for someone with a very high cardiac risk,’ she said, adding that, to date, all SGLT2 inhibitors appeared to be kidneyprotective.
Professor Gunton said that in the absence of contraindications to SGLT2 inhibitors – mostly problematic thrush or recurrent urinary tract infections – these drugs should be considered for an add-on after metformin.
‘Metformin predates the cardiovascular safety trials but is more effective for [lowering] HbA1c [levels] and is probably also cardioprotective,’ Professor Gunton told Medicine Today. ‘After metformin, then, [doctors] should individualise treatment and consider the next step. Our PBS guidelines will, of course, influence prescribing as they affect cost to the patient.’ She said lifestyle changes remained the best approach for type 2 diabetes and should be revisited with each progressive step in diabetes therapies.
J Am Heart Assoc. 2020; 9: e014908; doi: 10.1161/JAHA.119.014908.