Photo Credit: iStock.com/outline205

SGLT2 inhibitors reduced total cardiovascular risk by 18% in type 2 diabetes, with greatest benefit in patients at high risk for CVD recurrence.

In patients with type 2 diabetes, sodium-glucose cotransporter 2 inhibitors (SGLT2is) significantly decreased total cardiovascular disease (CVD) risk compared with dipeptidyl peptidase 4 inhibitors (DPP4is), according to a study published in JAMA Network Open.

“Findings from this cohort study suggest that long-term use of SGLT2i therapy should be encouraged, especially for patients at high risk for CVD recurrence, to alleviate excess CVD burden,” wrote corresponding author Huang-Tz Ou, PhD, and colleagues.

The real-world study used electronic medical record data for 1,632 propensity score-matched pairs of patients with type 2 diabetes from National Cheng Kung University Hospital, a leading medical center in Taiwan. Participants initiated first use of SGLT2i or DPP4i therapy from 2016 to 2019 and were followed for up to 6 years.

The study’s primary outcomes were composite CVD events and individual CVD subtypes, including atrial fibrillation, coronary heart disease, heart failure, stroke, and myocardial infarction.

The study found an 18% decrease in total CVD risk with SGLT2i compared with DPP4i therapy in the overall cohort. However, SGLT2i vs DPP4i therapy was not significantly associated with reduced time to a first composite CVD event.

SGLT2is were associated with the greatest benefit — up to a 30% risk reduction — for patients in subgroups linked with a high risk of CVD recurrence (those with an estimated glomerular filtration rate lower than 60 mL/min/1.73m², with any diabetes-related complications, or with a history of CVD) and with specific patient characteristics including female sex and comorbid chronic kidney disease.

“These potential heterogeneous associations of SGLT2is with outcomes by demographic (ie, sex) and clinical (ie, comorbid chronic kidney disease) characteristics suggest a need for personalized treatments tailored by relevant patient characteristics to maximize treatment benefits,” the researchers wrote.

The SGLT2i treatment benefit was not uniform across CVD subtypes, according to the study. With SGLT2i therapy, risks were decreased more for myocardial infarction (0.57 hazard ratio) and heart failure (0.65 hazard ratio) than for stroke (0.91 hazard ratio), coronary heart disease (0.89 hazard ratio), and atrial fibrillation (0.78 hazard ratio).

“These findings imply that SGLT2i therapy may be associated with benefits not only for heart failure,” the researchers wrote, “but also for atherosclerotic cardiovascular conditions (eg, myocardial infarction), which is in line with prior study findings.”