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SGLT2 Inhibitors and Prevention of Cardiovascular Events in Diabetes Patients with and Without Hypertension: A

Fu-Shun Yen1, James Cheng-Chung Wei2,3,4, Yao-Min Hung5,6,7

  • 1Dr. Yen's Clinic, No. 15, Shanying Road, Gueishan District, Taoyuan City, 33354, Taiwan.

Journal of General Internal Medicine
|October 7, 2025
PubMed
Abstract

Insights

Sodium-glucose cotransporter-2 inhibitors (SGLT2i) reduce cardiovascular risks in type 2 diabetes patients. SGLT2i use lowers stroke, heart failure, and MACE in hypertensive patients and atrial fibrillation in non-hypertensive patients.

Area of Science:

  • Cardiology
  • Endocrinology
  • Pharmacology

Background:

  • Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are increasingly used for type 2 diabetes (T2D) management.
  • The role of SGLT2i in the primary prevention of major adverse cardiovascular events (MACE) in T2D patients without pre-existing cardiovascular disease (CVD) requires further elucidation.

Purpose of the Study:

  • To investigate the association between SGLT2i use and the risk of primary cardiovascular events in T2D patients without CVD, stratified by hypertension status.
  • To compare the cardiovascular outcomes of SGLT2i users versus dipeptidyl peptidase-4 (DPP-4) inhibitor users.

Main Methods:

  • A nationwide cohort study utilizing Taiwan's National Health Insurance Research Database (2008-2021).
  • Propensity score matching was employed to create comparable cohorts of SGLT2i users and DPP-4 inhibitor users, including 9520 pairs with hypertension and 3496 pairs without hypertension.
  • Cox proportional hazards models were utilized to assess the risk of cardiovascular outcomes.

Main Results:

  • In patients with hypertension, SGLT2i use was significantly associated with reduced risks of stroke (aHR 0.56), coronary artery disease (aHR 0.80), heart failure (aHR 0.31), and MACE (aHR 0.62).
  • In patients without hypertension, SGLT2i use was significantly associated with a reduced risk of atrial fibrillation (aHR 0.48).
  • Mean follow-up duration was approximately 2.8 years for both hypertensive and non-hypertensive cohorts.

Conclusions:

  • SGLT2i use is associated with a lower risk of major adverse cardiovascular events, including coronary heart disease, stroke, and heart failure, in type 2 diabetes patients with hypertension and without prior cardiovascular disease.
  • In type 2 diabetes patients without hypertension, SGLT2i use demonstrated a reduced risk of atrial fibrillation.
  • These findings suggest a potential role for SGLT2i in the primary prevention of cardiovascular events among patients with type 2 diabetes.
Keywords:
Atrial fibrillationCoronary artery diseaseHeart failureMajor adverse cardiovascular eventsSGLT2i stroke

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