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Sodium-Glucose Co-Transporter 2 Inhibitor Use and Risk of Major Adverse Cardiovascular Events in Patients With
Meet Popatbhai Kachhadia1, Piyush Puri2, Krina Patel3
1Department of Neurology, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA.
Journal of Clinical Medicine Research
|June 22, 2026
Summary
Sodium-glucose co-transporter 2 (SGLT2) inhibitors showed a trend towards lower cardiovascular events in rheumatoid arthritis (RA) and type 2 diabetes mellitus (T2DM) patients compared to dipeptidyl peptidase-4 (DPP-4) inhibitors, but results were not statistically significant.
Area of Science:
- Cardiovascular medicine
- Endocrinology
- Rheumatology
Background:
- Patients with rheumatoid arthritis (RA) and type 2 diabetes mellitus (T2DM) have a higher risk of cardiovascular disease.
- Sodium-glucose co-transporter 2 (SGLT2) inhibitors offer cardiovascular benefits in diabetic populations.
- The efficacy of SGLT2 inhibitors in RA patients with T2DM is not well-established.
Purpose of the Study:
- To compare the risk of major adverse cardiovascular events (MACEs) between SGLT2 inhibitor users and dipeptidyl peptidase-4 (DPP-4) inhibitor users.
- To investigate MACE risk in patients with concurrent RA and T2DM.
Main Methods:
- Retrospective cohort study using the TriNetX US Collaborative Network database.
- Identified adult patients with RA and T2DM prescribed either SGLT2 inhibitors (n=823) or DPP-4 inhibitors (n=284).
- Propensity score matching (1:1) created 277 matched pairs; MACE endpoint included myocardial infarction, cerebral infarction, heart failure, cardiovascular death, and cardiac arrest.
Main Results:
- SGLT2 inhibitor group had numerically lower MACE risk (43.0% vs. 48.7%), but this was not statistically significant (P=0.172).
- Median survival time was shorter in the SGLT2 inhibitor group (2,227 days vs. 2,750 days).
- Kaplan-Meier analysis showed a borderline difference in event-free survival (log-rank P=0.051), but proportional hazards assumption was violated, making Cox regression results uninterpretable.
Conclusions:
- SGLT2 inhibitors showed a non-significant trend towards reduced MACE in RA and T2DM patients compared to DPP-4 inhibitors.
- Limited statistical power and differential follow-up duration may have impacted results.
- Further adequately powered prospective studies are needed to confirm cardiovascular benefits in this population.
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