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Cardiovascular outcomes of sodium glucose cotransporter‐2 inhibitors in patients with type 2 diabetes
Author(s) -
Dawwas Ghadeer K.,
Smith Steven M.,
Park Haesuk
Publication year - 2019
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.13477
Subject(s) - dapagliflozin , medicine , canagliflozin , hazard ratio , type 2 diabetes , empagliflozin , diabetes mellitus , myocardial infarction , lower risk , population , heart failure , stroke (engine) , confidence interval , dipeptidyl peptidase 4 , proportional hazards model , pharmacology , endocrinology , mechanical engineering , environmental health , engineering
Aims To determine the association between cardiovascular diseases (CVD) and SGLT2 inhibitors compared to sulfonylureas and dipeptidyl peptidase‐4 (DPP4) inhibitors and to examine within‐class effects of SGLT2 inhibitors. Methods A retrospective cohort analysis was conducted using Truven Health MarketScan. New users of SGLT2 inhibitors, sulfonylureas or DPP‐4 inhibitors were included. Primary outcome was incident CVD, defined as non‐fatal myocardial infarction or non‐fatal stroke; secondary outcomes were hospitalization because of heart failure and lower extremity amputation. Proportional hazards models, after propensity score matching, were used to obtain hazard ratios (HR) and 95% confidence intervals (CI). Results In fully adjusted models, use of SGLT2 inhibitors was associated with a decreased risk of developing CVD compared with use of sulfonylureas (HR, 0.50; 95% CI, 0.45, 0.55) and DPP‐4 inhibitors (HR, 0.57; 95% CI, 0.52, 0.62), respectively. Analyses revealed no evidence of within‐class effects: dapagliflozin vs sulfonylureas (HR, 0.55; 95% CI, 0.43, 0.70) or DPP‐4 inhibitors (HR, 0.57; 95% CI, 0.46, 0.70); and canagliflozin vs sulfonylureas (HR, 0.61; 95% CI, 0.54, 0.69) or DPP‐4 inhibitors (HR, 0.66; 95% CI, 0.54, 0.71). Additionally, SGLT2 inhibitors were associated with lower risk of hospitalization because of heart failure compared to both sulfonylureas and DPP‐4 inhibitors, as well as lower risk of lower extremity amputation compared to sulfonylureas. Conclusion Using population‐based data, incident use of SGLT‐2 inhibitors was associated with a decreased incidence of CVD compared to use of sulfonylureas and DPP‐4 inhibitors. These findings were consistent between dapagliflozin and canagliflozin, suggesting that CVD reduction is a class effect for SGLT2 inhibitors. In addition, SGLT2 inhibitors portended lower risk of hospitalization because of heart failure (vs sulfonylureas and DPP‐4 inhibitors) and lower risk of lower extremity amputation (vs sulfonylureas).