Cardiovascular Risks With SGLT2 Inhibitors in Clinical Practice Among Patients With Type 2 Diabetes

Area of Science:

• Cardiology
• Endocrinology
• Pharmacology

Background:

• Cardiovascular disease (CVD) recurrence is a significant concern in aging populations with type 2 diabetes (T2D).
• The comparative effectiveness of sodium-glucose cotransporter 2 inhibitors (SGLT2i) versus dipeptidyl peptidase 4 inhibitors (DPP4i) for total CVD events in T2D patients in clinical practice is not well-established.

Purpose of the Study:

• To compare the association of SGLT2i therapy versus DPP4i therapy with total CVD events in patients with T2D.
• To evaluate the effectiveness of SGLT2i in reducing both first and subsequent CVD events.

Main Methods:

• A retrospective cohort study utilizing electronic medical records from a leading Taiwanese hospital (2015-2021).
• Included adult T2D patients initiating SGLT2i or DPP4i therapy (2016-2019) with up to 6 years of follow-up.
• Propensity score matching and shared frailty models were used to analyze total composite CVD events and subtypes, including repeat events.

Main Results:

• SGLT2i therapy was associated with a reduced risk of total CVD events compared to DPP4i therapy (HR, 0.82; 95% CI, 0.69-0.98).
• This benefit was more significant in high-risk T2D patients, including those with estimated glomerular filtration rate <60 mL/min/1.73 m², diabetes-related complications, or a history of CVD.
• Among high-risk patients, SGLT2i showed a greater reduction in total CVD burden for women compared to men, especially those with a history of CVD.

Conclusions:

• SGLT2i therapy is associated with a reduced total cardiovascular burden in T2D patients compared to DPP4i therapy.
• Long-term SGLT2i use may optimize treatment benefits for patients with chronic CVD.
• Prioritizing SGLT2i use for high-risk T2D individuals, particularly women, is encouraged due to observed benefits in reducing CVD recurrence.