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October 2020

Real world study confirms lower risk of cardiovascular events with SGLT2 inhibitors

A real world study has confirmed that SGLT2inhibitors are associated with a lower short term risk of major heart problems in patients with type 2 diabetes than DPP-4 inhibitors.

The study published in The BMJ follows on from a series of cardiovascular outcome trials (CVOTs) that have shown that SGLT2 inhibitors can reduce the risk of heart conditions such as heart attack, stroke, and heart failure compared with placebo.

But some of these trials had important limitations, making it difficult to interpret the results, and data on the effects of individual SGLT2 inhibitors on the heart are limited.

The new study, set in clinical practice in the UK and seven Canadian provinces from 2013–18 and involving around 420,000 patients, found significant reductions in the risk of heart attack, stroke or cardiovascular death combined (11.4 events per 1000 person years versus 16.5 events per 1000 person years) with SGLT2 inhibitors compared with DPP-4 inhibitors, as well as decreased risks of individual events, although the benefits for stroke reduction were more modest.

This is an observational study, so can’t establish cause, and the researchers point to some limitations, such as relying on prescription data over a relatively short follow-up period (11 months). What’s more, they cannot rule out the possibility that other unmeasured (confounding) factors may have affected their results.

However, results were consistent across several analyses, suggesting that they withstand scrutiny.

As such, they say these findings suggest that SGLT2 inhibitors ‘offer cardioprotective benefits among people with type 2 diabetes in a real world setting, although additional studies are needed to determine if these benefits persist long term.’

Filion KB, et al.

Practice Nurse 2020;50(8):6