SGLT-2 Inhibitors and Cardiovascular Risk An Analysis of CVD-REAL

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:71

Article

Cavender, Matthew A.^1,2  Norhammar, Anna³  Birkeland, Kare I.^4,5  Jorgensen, Marit Eika^6,7  Wilding, John P.⁸  Khunti, Kamlesh⁹  Fu, Alex Z.¹⁰  Bodegard, Johan¹¹  Blak, Betina T.¹²  Wittbrodt, Eric¹³  Thuresson, Marcus¹⁴  Fenici, Peter¹⁵  Hammar, Niklas^3,16  Kosiborod, Mikhail^17,18 

[1] Univ N Carolina, Burnett Womack Bldg,160 Dent Circle,CB 7075, Chapel Hill, NC 27599 USA

[2] Baim Inst Clin Res, Boston, MA USA

[3] Karolinska Inst, Stockholm, Sweden

[4] Univ Oslo, Inst Clin Med, Oslo, Norway

[5] Oslo Univ Hosp, Dept Transplantat Med, Oslo, Norway

[6] Steno Diabet Ctr, Copenhagen, Denmark

[7] Univ Southern Denmark, Natl Inst Publ Hlth, Odense, Denmark

[8] Univ Liverpool, Inst Ageing & Chron Dis, Liverpool, Merseyside, England

[9] Univ Leicester, Diabet Res Ctr, Leicester, Leics, England

[10] Georgetown Univ, Med Ctr, Washington, DC 20007 USA

[11] AstraZeneca, Oslo, Norway

[12] AstraZeneca, Luton, Beds, England

[13] AstraZeneca, Wilmington, DE USA

[14] Statisticon AB, Uppsala, Sweden

[15] AstraZeneca, Cambridge, England

[16] AstraZeneca, Gothenburg, Sweden

[17] St Lukes Mid Amer Heart Inst, Kansas City, MO USA

[18] Univ Missouri, Kansas City, MO USA

关键词: cardiovascular disease;    CVD-REAL;    heart failure;    sodium-glucose co-transporter 2 inhibitors;   

DOI  :  10.1016/j.jacc.2018.01.085

来源: Elsevier

【 摘 要 】

BACKGROUND Prior studies found patients treated with sodium-glucose co-transporter-2 inhibitors (SGLT-2i) had lower rates of death and heart failure (HF). Whether the benefits of SGLT-2i vary based upon the presence of cardiovascular disease (CVD) is unknown. OBJECTIVES This study sought to determine the association between initiation of SGLT-2i therapy and HF or death in patients with and without CVD. METHODS The CVD-REAL (Comparative Effectiveness of Cardiovascular Outcomes in New Users of SGLT-2 Inhibitors) study was a multinational, observational study in which adults with type 2 diabetes were identified. Patients prescribed an SGLT-2i or other glucose-lowering drugs (GLDs) were matched based on a propensity score for initiation of an SGLT-2i. Hazard ratios (HRs) for the risk of death, HF, and HF or death in patients with and without established CVD were estimated for each country and pooled. RESULTS After propensity score matching, 153,078 patients were included in each group. At baseline, 13% had established CVD. Compared with therapy using other GLDs, initiation of an SGLT-2i was associated with lower risk of death in patients with and without CVD (HR: 0.56; 95% confidence interval [CI]: 0.44 to 0.70; and HR: 0.56; 95% CI: 0.50 to 0.63, respectively). There were also associations between SGLT-2i and lower risk of HF (HR:0.72; 95% CI: 0.63 to 0.82; and HR: 0.61; 95% CI: 0.48 to 0.78, respectively) and the composite of HF or death (HR: 0.63; 95% CI: 0.57 to 0.70; and HR: 0.56; 95% CI: 0.50 to 0.62, respectively) observed in patients with and without established CVD. CONCLUSIONS In this large, multinational, observational study, initiation of SGLT-2i was associated with lower risk of death and HF regardless of pre-existing CVD. Ongoing clinical trials will provide further evidence regarding the benefit of SGLT-2i in patients without established CVD. (Comparative Effectiveness of Cardiovascular Outcomes in New Users of SGLT-2 Inhibitors [CVD-REAL]; NCT02993614) (c) 2018 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license.

【 授权许可】

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