SGLT2i beats DPP4i at reducing cardiovascular disease in type 2 diabetes

Treatment with sodium-glucose cotransporter 2 inhibitors (SGLT2i) leads to lower rates of cardiovascular disease (CVD) events in patients with type 2 diabetes mellitus (T2DM) than does dipeptidyl peptidase-4 inhibitors (DPP4i), reports a recent Japan study.

Researchers retrospectively examined 625,739 T2DM patients, of whom 9.1 percent (n=57,070) were new users of SGLT2is, and 90.9 percent (n=568,669) of DPP4is. CVD event outcomes included hospitalization for heart failure (hHF), all-cause death (ACD), and their composite.

Cox proportional hazards analysis found that SGLT2is significantly reduced the risk of hHF by almost half in T2DM patients without a history of CVD (hazard ratio [HR], 0.507, 95 percent confidence interval [CI], 0.283–0.907). Of note, no such effect was reported in the full cohort or in those who had had CVD episodes in the past.

Meanwhile, SGLT2i treatment significantly decreased ACD in the whole cohort as compared with DPP4i (HR, 0.592, 95 percent CI, 0.481–0.729). A similar effect was reported for the composite of hHF and ACD (HR, 0.712, 95 percent CI, 0.613–0.826). Stratifying the analysis of ACD and the composite outcome between patients with and without CVD histories did not alter the principal findings.

“Findings suggest that early initiation of SGLT2i might provide cardioprotective effects in patients without a CVD history,” the researchers said. “Collectively, SGLT2i should not be excluded as a first-line treatment option for improved and integrated management of both T2DM control and CVD prevention.”