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Dapagliflozin is associated with lower risk of cardiovascular events and all‐cause mortality in people with type 2 diabetes ( CVD‐REAL Nordic ) when compared with dipeptidyl peptidase‐4 inhibitor therapy: A multinational observational study
Author(s) -
Persson Frederik,
Nyström Thomas,
Jørgensen Marit E.,
Carstensen Bendix,
Gulseth Hanne L.,
Thuresson Marcus,
Fenici Peter,
Nathanson David,
Eriksson Jan W.,
Norhammar Anna,
Bodegard Johan,
Birkeland Kåre I.
Publication year - 2018
Publication title -
diabetes, obesity and metabolism
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.445
H-Index - 128
eISSN - 1463-1326
pISSN - 1462-8902
DOI - 10.1111/dom.13077
Subject(s) - dapagliflozin , medicine , hazard ratio , mace , type 2 diabetes , myocardial infarction , diabetes mellitus , confidence interval , proportional hazards model , propensity score matching , dipeptidyl peptidase 4 , lower risk , stroke (engine) , hypoglycemia , cardiology , endocrinology , insulin , percutaneous coronary intervention , mechanical engineering , engineering
Aims To compare the sodium‐glucose‐cotransporter‐2 (SGLT‐2) inhibitor dapagliflozin with dipeptidyl peptidase‐4 (DPP‐4) inhibitors with regard to risk associations with major adverse cardiovascular (CV) events (MACE; non‐fatal myocardial infarction, non‐fatal stroke or cardiovascular mortality), hospitalization for heart failure (HHF), atrial fibrillation and severe hypoglycaemia in patients with type 2 diabetes (T2D) in a real‐world setting. Methods All patients with T2D prescribed glucose‐lowering drugs (GLDs) during 2012 to 2015 were identified in nationwide registries in Denmark, Norway and Sweden. Patients were divided into two groups: new users of dapagliflozin and new users of DPP‐4 inhibitors, matched 1:3 by propensity score, calculated by patient characteristics, comorbidities and drug treatment. Cox survival models were used to estimate hazard ratio (HR) per country separately, and a weighted average was calculated. Results After matching, a total of 40 908 patients with T2D were identified as new users of dapagliflozin (n = 10 227) or a DPP‐4 inhibitor (n = 30 681). The groups were well balanced at baseline; their mean age was 61 years and 23% had CV disease. The mean follow‐up time was 0.95 years, with a total of 38 760 patient‐years. Dapagliflozin was associated with a lower risk of MACE, HHF and all‐cause mortality compared with DPP‐4 inhibitors: HRs 0.79 (95% confidence interval [CI] 0.67‐0.94), 0.62 (95% CI 0.50‐0.77), and 0.59 (95% CI 0.49‐0.72), respectively. Numerically lower, but non‐significant HRs were observed for myocardial infarction (0.91 [95% CI 0.72‐1.16]), stroke (0.79 [95% CI 0.61‐1.03]) and CV mortality (0.76 [95% CI 0.53‐1.08]) Neutral associations with atrial fibrillation and severe hypoglycaemia were observed. Conclusions Dapagliflozin was associated with lower risks of CV events and all‐cause mortality compared with DPP‐4 inhibitors in a real‐world clinical setting and a broad T2D population.