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Related Concept Videos

Strategies for Assessing and Addressing Confounding01:25

Strategies for Assessing and Addressing Confounding

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Confounding is a critical issue in epidemiological studies, often leading to misleading conclusions about associations between exposures and outcomes. It occurs when the relationship between the exposure and the outcome is mixed with the effects of other factors that influence the outcome. Given that, addressing confounding is of high importance for drawing accurate inferences in research.
Confounding can be addressed at both the design phase of a study and through analytical methods after data...
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Sampling is a technique to select a portion (or subset) of the larger population and study that portion (the sample) to gain information about the population. The sampling method ensures that samples are drawn without bias and accurately represent the population. Because measuring the entire population in a study is not practical, researchers use samples to represent the population of interest.
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Andrew Drexler1

  • 1The University of California, Los Angeles, Los Angeles, CA, USA.

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Sodium-glucose cotransporter 2 (SGLT2) inhibitors demonstrate a class effect in reducing cardiovascular events and heart failure hospitalizations in type 2 diabetes patients. These findings suggest SGLT2 inhibitors may become a preferred second-line therapy after metformin.

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Area of Science:

  • Cardiology
  • Endocrinology
  • Pharmacology

Background:

  • The cardiovascular benefits of empagliflozin observed in the EMPA-REG trial raised questions about whether these effects were specific to the drug or a class effect of sodium-glucose cotransporter 2 (SGLT2) inhibitors.
  • The CANagliflozin cardioVascular Assessment Study (CANVAS) and the CVD-REAL observational study were conducted to address these questions, evaluating the cardiovascular outcomes associated with SGLT2 inhibitors.

Discussion:

  • Both the CANVAS and EMPA-REG trials demonstrated a significant reduction in the composite endpoint of cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke.
  • The CVD-REAL study, analyzing real-world data, further supported these findings, showing consistent benefits of SGLT2 inhibitors across different drugs and countries.
  • While SGLT2 inhibitors showed benefits in reducing heart failure hospitalizations and mortality, they did not consistently reduce non-fatal myocardial infarctions, suggesting mechanisms beyond direct atherosclerotic improvement.

Key Insights:

  • The cardiovascular benefits of SGLT2 inhibitors are a class effect, not specific to empagliflozin.
  • SGLT2 inhibitors significantly reduce the risk of cardiovascular death, heart failure hospitalizations, and all-cause mortality in patients with type 2 diabetes.
  • Potential risks, such as increased risk of lower extremity amputations with canagliflozin, require careful consideration.

Outlook:

  • SGLT2 inhibitors are likely to receive expanded indications for the secondary prevention of heart failure.
  • The role of SGLT2 inhibitors in primary prevention of heart failure requires further investigation through large-scale clinical trials.
  • SGLT2 inhibitors may represent a preferred second-line therapy option for type 2 diabetes management following metformin.