Comparison of cardiovascular outcomes between SGLT2 inhibitors in diabetes mellitus
AbstractBackground. There have been scarce data comparing cardiovascular outcomes between individual sodium-glucose cotransporter‑2 (SGLT2) inhibitors. We aimed to compare the subsequent cardiovascular risk between individual SGLT2 inhibitors.
Methods. We analyzed 25 315 patients with diabetes mellitus (DM) newly taking SGLT2 inhibitors (empaglifozin: 5302, dapaglifozin: 4681, canaglifozin: 4411, other SGLT2 inhibitors: 10 921). We compared the risks of developing heart failure (HF), myocardial infarction (MI), angina pectoris (AP), stroke, and atrial fbrillation (AF) between individual SGLT2 inhibitors.
Results. Median age was 52 years, and 82.5% were men. The median fasting plasma glucose and HbA1c levels were 149 (Q1–Q3: 127–182) mg/dL and 7.5% (Q1–Q3: 6.9–8.6%). During a mean follow-up of 814±591 days, 855 HF, 143 MI, 815 AP, 340 stroke, and 139 AF events were recorded. Compared with empaglifozin, the risk of developing HF, MI, AP, stroke, and AF was not signifcantly diferent in dapaglifozin, canaglifozin, and other SGLT inhibitors. For developing HF, compared with empaglifozin, hazard ratios of dapaglifozin, canaglifozin, and other SGLT2 inhibitors were 1.02 [95% confdence interval (CI) 0.81–1.27], 1.08 (95% CI 0.87–1.35), and 0.88 (95% CI 0.73–1.07), respectively. Wald tests showed that there was no signifcant diference in the risk of developing HF, MI, AP, stroke, and AF among individual SGLT2 inhibitors. We confrmed the robustness of these results through a multitude of sensitivity analyses.
Conclusion. The risks for subsequent development of HF, MI, AP, stroke, and AF were comparable between individual SGLT2 inhibitors. This is the frst study comparing the wide-range cardiovascular outcomes of patients with DM treated with individual SGLT2 inhibitors using large-scale real-world data.
Keywords:SGLT2 inhibitor; cardiovascular disease; diabetes mellitus
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