Sodium-glucose transporter 2 (SGLT2) inhibitors lower the risk of major adverse cardiovascular (CV) outcomes in people with type-2 diabetes, according to a new meta-analysis including the four available drugs in the class. Outcomes were heterogeneous for CV death, and most consistent for hospitalization for heart failure (HHF) and kidney outcomes, Dr. Darren K. McGuire of the University of Texas Southwestern Medical Center in Dallas and colleagues found. "The present results augment the growing evidence base that SGLT2 inhibitors in general are associated with favorable CV and kidney outcomes; in addition, the present study refines understanding of important differences in outcomes associated with drugs within the class," Dr. McGuire and colleagues write in JAMA Cardiology. The authors analyzed six randomized controlled trials of SGLT2 inhibitors including nearly 47,000 patients with type-2 diabetes, two-thirds of whom had atherosclerotic CV disease. Patients' mean age was 63.7 years, 65.9% were men and 78.5% were white. Major adverse CV events (MACE) occurred in 4,931 patients. There were 2,031 CV deaths, 3,154 HF-/CV-death composite events, 1,430 HHF events and 1,426 kidney composite outcome events. SGLT2 inhibitors were linked to a significantly reduced likelihood of major adverse CV events (hazard ratio, 0.90), HHF/CV death (HR, 0.78) and kidney outcomes (HR, 0.62). All of the SGLT2 inhibitors reduced HHF risk to a similar degree (HR, 0.68), but there was heterogeneity among the drugs for CV death. "These data support contemporary society recommendations to prioritize the use of SGLT2 inhibitors with demonstrated outcomes, independent of glucose control considerations, in patients with T2D with or at high risk for CV and kidney complications. The heterogeneity of the associations with outcomes of different SGLT2 inhibitors on CV death among patients with T2D and ASCVD requires further study," the authors conclude. Dr. McGuire and his colleagues report financial relationships with multiple pharmaceutical companies, and some authors are employees of and shareholders in Merck or Pfizer. —Reuters Staff Source
