Pioglitazone–SGLT2 inhibitor combo delivers for primary CV prevention in diabetes

Combination treatment with pioglitazone plus a sodium-glucose co-transporter 2 (SGLT2) inhibitor helps reduce the risk of developing major adverse cardiovascular events (MACE) and heart failure in individuals with type 2 diabetes mellitus (T2DM) who have no history of cardiovascular disease (CV), as reported in a study.

Researchers used data from the Taiwan National Health Insurance Research Database and identified four groups of people with T2DM who used the following medications: 1) both SGLT2 inhibitors and pioglitazone, 2) SGLT2 inhibitors only, 3) pioglitazone only, and 4) nonstudy drugs (reference group).

Propensity score was applied to match the four groups. The primary outcome was three-point MACE, which included myocardial infarction, stroke, and cardiovascular death. The secondary outcome was heart failure.

Each of the four treatment groups included 15,601 participants. Multivariable Cox regression analysis showed that compared with the reference group, the pioglitazone/SGLT2 inhibitor combination group had a much lower risk of both MACE (adjusted hazard ratio [aHR], 0.76, 95 percent confidence interval [CI], 0.66–0.88) and heart failure (aHR, 0.67, 95 percent CI, 0.55–0.82).

Meanwhile, the pioglitazone group had a lower risk of MACE (aHR, 0.82, 95 percent CI, 0.71–0.94) but similar risk of heart failure relative to the reference group. The SGLT2i group, on the other hand, had a significantly decreased risk of heart failure compared with the reference group (aHR, 0.7, 95 percent CI, 0.58–0.86).