Canagliflozin is a sodium-glucose cotransporter 2 inhibitor drug used to treat type-2 diabetes. While not certain, the use of canagliflozin had been linked with an increased risk of cardiovascular events. This study aims to compare the cardiovascular safety of canagliflozin with other routine antidiabetic drugs like DPP-4 inhibitors, DPP-4 inhibitors, and sulfonylureas.

This population-based retrospective cohort study included three pairwise 1:1 propensity score-matched cohorts of patients aged 18 years or older with type-2 diabetes. The eligible participants initiated canagliflozin or a comparator non-gliflozin antidiabetic agent, like DPP-4i, a GLP-1RA, or a sulfonylurea. The primary outcome of this study was heart failure as a consequence of acute myocardial infarction (MI), ischemic stroke, or hemorrhagic stroke.

During 30 months of evaluation, the risk of cardiovascular events (hazard ratio) with the use of canagliflozin versus DPP-4i, GLP-1RA, and sulfonylurea was 0.61, 0.61, and 0.51, respectively. The risk of composite cardiovascular endpoint associated with canagliflozin versus DPP-4i (0.89), GLP-1RA (1.03), and sulfonylurea (0.86) was also similar.

The research concluded that canagliflozin was not associated with a higher risk of heart failure admission to the hospital. The findings further suggested that canagliflozin had a similar risk of MI or stroke as with DPP-4i, a GLP-1RA, or a sulfonylurea.