SGLT2i better than DDP4i at preventing heart failure hospitalization, death in T2DM

Sodium-glucose cotransporter 2 inhibitors (SGLT2is) reduce hospitalization for heart failure (hHF) and all-cause death in type 2 diabetes mellitus (T2DM) patients without a history of cardiovascular disease (CVD), reports a new study.

Researchers conducted a retrospective analysis of 625,739 T2DM patients who were new users of SGLT2is (n=57,070; median age 71 years, 64.3 percent men) or dipeptidyl peptidase-4 inhibitors (DPP4is; n=568,669; median age 72 years, 61.8 percent men). Outcomes, including hHF, all-cause death, and their composite, were compared between treatment groups.

Inverse probability weighting Cox proportional hazards models showed that SGLT2is led to a significant reduction in hHF risk in patients without a CVD history (hazard ratio [HR], 0.507, 95 percent confidence interval [CI], 0.283–0.907). No such effect was reported in the full cohort (HR, 0.936, 95 percent CI, 0.765–1.146) or in patients with a history of CVD (HR, 0.978, 95 percent CI, 0.707–1.353).

Meanwhile, risk of all-cause death was significantly lower in the SGLT2i-treated patients in the whole cohort (HR, 0.592, 95 percent CI, 0.481–0.729) and those with (HR, 0.573, 95 percent CI, 0.437–0.752) and without (HR, 0.640, 95 percent CI, 0.457–0.897) a history of CVD. The composite of both endpoints was likewise reduced in the overall cohort and in both CVD subcohorts.

“Findings suggest that early initiation of SGLT2i may 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, especially hHF and all-cause death, in patients with T2DM.”