Empagliflozin is associated with lower cardiovascular risk compared with dipeptidyl peptidase-4 inhibitors in adults with and without cardiovascular disease: EMPagliflozin compaRative effectIveness and SafEty (EMPRISE) study results from Europe and Asia

Cardiovascular Diabetology

Research

Johannes Foersch¹  Soulmaz Fazeli Farsani¹  Christina Shay²  Marc Carrasco³  Júlio Núñez⁴  Sigrun Halvorsen⁵  Thomas Nyström⁶  Dae Jung Kim⁷  Kyoung Hwa Ha⁷  Gisle Langslet⁸  Elise Chia-Hui Tan⁹  Patorno Elisabetta^1,10  Fabian Hoti^1,11  Sonia Guleria^1,12  Riho Klement^1,13  Wayne H.-H. Sheu^1,14  Reinhard W. Holl^1,15  Stefanie Lanzinger^1,16  Anuradhaa Subramanian^1,17  Krishnarajah Nirantharakumar^1,18  Kamlesh Khunti^1,19  Francesco Zaccardi^1,19  Lisette Koeneman^2,20  Cheli Melzer-Cohen^2,21  Avraham Karasik^2,21  Leo Niskanen^2,22  Bendix Carstensen^2,23  Dorte Vistisen^2,24  Daisuke Yabe^2,25 

[1] Boehringer Ingelheim International GmbH, Ingelheim, Germany;Boehringer Ingelheim Pharmaceuticals USA, 00 Ridgebury Road, 06877, Ridgefield, CT, USA;Boehringer Ingelheim Pharmaceuticals, Inc., Barcelona, Spain;Department of Cardiology, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, CIBER Cardiovascular, Valencia, Spain;Department of Cardiology, Oslo University Hospital Ullevål, University of Oslo, Oslo, Norway;Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden;Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, South Korea;Department of Endocrinology, Morbid Obesity and Preventive Medicine, Lipid Clinic, Oslo University Hospital, Oslo, Norway;Department of Health Service Administration, China Medical University, Taichung, Taiwan;Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA;IQVIA, Espoo, Finland;IQVIA, Goteborg, Sweden;IQVIA, Tartu, Estonia;Insititute of Molecular and Genomic Medicine, National Health Research Institutes, Taipei City, Taiwan;Institute for Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany;Institute for Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany;German Centre for Diabetes Research (DZD), Munich-Neuherberg, Germany;Institute of Applied Health Research, University of Birmingham, Birmingham, UK;Institute of Applied Health Research, University of Birmingham, Birmingham, UK;Midlands Health Data Research UK, Birmingham, UK;DEMAND Hub, University of Birmingham, Birmingham, UK;Leicester Real World Evidence Unit, Leicester Diabetes Centre, University of Leicester, Leicester, UK;Lilly Deutschland GmbH, Bad Homburg, Germany;Maccabi Institute for Research and Innovation, Maccabi Healthcare Services, Tel-Aviv, Israel;Päijät-Häme Joint Authority for Health and Wellbeing, Päijät-Häme Central Hospital, Lahti, Finland;University of Eastern Finland, Kuopio, Finland;Steno Diabetes Center Copenhagen, Copenhagen, Denmark;Steno Diabetes Center Copenhagen, Copenhagen, Denmark;Department of Public Health, University of Copenhagen, Copenhagen, Denmark;Yutaka Seino Distinguished Centre for Diabetes Research, Kansai Electric Power Medical Research Institute, Kobe, Japan;Department of Diabetes, Metabolism and Endocrinology/Department of Rheumatology and Clinical Immunology, Gifu University Graduate School of Medicine, Gifu, Japan;Center for Healthcare Information Technology, Tokai National Higher Education and Research System, Nagoya, Japan;Preemptive Food Research Centre, Gifu University Institute for Advanced Study, Gifu, Japan;

关键词: Empagliflozin;    Dipeptidyl peptidase-4 inhibitors;    Type 2 diabetes;    Cardiovascular disease;    Heart failure;    Comparative effectiveness;   

DOI  :  10.1186/s12933-023-01963-9

 received in 2023-02-17, accepted in 2023-08-12,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundStudies that have reported lower risk for cardiovascular outcomes in users of Sodium–Glucose Cotransporter-2 Inhibitors (SGLT-2i) are limited by residual cofounding and lack of information on prior cardiovascular disease (CVD). This study compared risk of cardiovascular events in patients within routine care settings in Europe and Asia with type 2 diabetes (T2D) initiating empagliflozin compared to dipeptidyl peptidase-4 inhibitors (DPP-4i) stratified by pre-existing CVD and history of heart failure (HF).Methods and resultsAdults initiating empagliflozin and DPP-4i in 2014–2018/19 from 11 countries in Europe and Asia were compared using propensity score matching and Cox proportional hazards regression to assess differences in rates of primary outcomes: hospitalisation for heart failure (HHF), myocardial infarction (MI), stroke; and secondary outcomes: cardiovascular mortality (CVM), coronary revascularisation procedure, composite outcome including HHF or CVM, and 3-point major adverse cardiovascular events (MACE: MI, stroke and CVM). Country-specific results were meta-analysed and pooled hazard ratios (HR) with 95% confidence intervals (CI) from random-effects models are presented.In total, 85,244 empagliflozin/DPP4i PS-matched patient pairs were included with overall mean follow-up of 0.7 years. Among those with pre-existing CVD, lower risk was observed for HHF (HR 0.74; 95% CI 0.64–0.86), CVM (HR 0.55; 95% CI 0.38–0.80), HHF or CVM (HR 0.57; 95% CI 0.48–0.67) and stroke (HR 0.79; 95% CI 0.67–0.94) in patients initiating empagliflozin vs DPP-4i. Similar patterns were observed among patients without pre-existing CVD and those with and without pre-existing HF.ConclusionThese results from diverse patient populations in routine care settings across Europe and Asia demonstrate that initiation of empagliflozin compared to DPP-4i results in favourable cardioprotective effects regardless of pre-existing CVD or HF status.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

【 图 表 】

Fig. 4