![]() Current medication and lifestyle interventions may not be sufficient to reduce the risk of serious cardiovascular disease outcomes in the primary prevention cohorts of type 2 diabetes. Patients with type 2 diabetes suffer substantial morbidity and mortality from cardiovascular disease. Future prospective studies are required to confirm the findings. The risk of cardiovascular events was similar between dapagliflozin and empagliflozin new users, but dapagliflozin may have a better outcome in the reduction of heart failure in type 2 diabetes patients. Compared to empagliflozin users, new users of dapagliflozin were found to have similar risks for primary composite outcome (adjusted HR: 0.91 95% CI 0.73–1.14), cardiovascular death (adjusted HR: 0.54 95% CI 0.14–2.12), myocardial infarction (adjusted HR: 0.77, 95% CI 0.49–1.19) and ischemic stroke (adjusted HR: 1.15 95% CI 0.80–1.65), but a lower risk of heart failure (adjusted HR: 0.68 95% CI 0.49–0.95). A total of 10,442 person-years of dapagliflozin use and 12,096 person-years of empagliflozin use were included. We identified 12,681 new SGLT2 inhibitor users with a mean age of 58.9 (SD 11.8) years, of whom 43.9% were female and 45.8% were new dapagliflozin users. We performed multivariable Cox proportional hazard modeling, adjusting for patients’ age, sex, laboratory data, co-morbidities, and concomitant medications. We followed up patients from initiation of SGLT2 inhibitors until the occurrence of cardiovascular events before December 31, 2018. The primary outcome was a composite of cardiovascular death, myocardial infarction, ischemic stroke and heart failure. We conducted a retrospective cohort study by analyzing a multi-institutional electronic medical records database (Chang Gung Research Database) in Taiwan and included adult type 2 diabetes patients who were newly receiving sodium–glucose co-transporter 2 (SGLT2) inhibitors from 2016 to 2017. Only canagliflozin increases the risk of amputations (RR increase 26%) & fractures (RR increase by 11%).To compare the cardiovascular event risk in type 2 diabetes patients newly receiving dapagliflozin vs. SGLT2 inhibitors do not reduce/increase stroke Īll SGLT2 inhibitors reduce the risk of HF hospitalization (RRR ~30%), regardless of prior ASCVD or HF.Īll SGLT2 inhibitors increase the risk of DKA (RR increase by 120%) SGLT2 inhibitors reduce the risk of major adverse CV events (composite of CV death/MI/stroke) in patients with existing ASCVD (RRR 14%), but not in those without ASCVD Only empagliflozin clearly reduces all-cause & CV mortality (in patients with existing ASCVD, RRR 32%) high rate of exclusion during placebo run-in)Ī meta-analysis of the 3 major CV outcome trials of SGLT2 inhibitors (CANVAS, DECLARE & EMPA-REG) shows the following overall patterns: ![]() ![]() ![]() Overall assessment of the evidence for SGLT2 inhibitors shows several differences between agents in this class empagliflozin appears to have the greatest potential for benefit, whereas canagliflozin has the highest potential for harm.Ĭontext: Summaries of EMPA-REG with empagliflozin & CANVAS with canagliflozinĮstablished atherosclerotic cardiovascular disease (ASCVD IHD, ischemic CVA, PAD) & 40+ y/o Dapaglifozin increases the risk of fungal genital infections (NNH 125) & DKA (NNH 500). NEJM Bottom line: In patients with type 2 diabetes with existing ASCVD or with multiple CV risk factors, dapagliflozin did not reduce the risk of a composite of major adverse cardiovascular events however, it did reduce the risk of HF hospitalizations (NNT 125) at 4.2 years. Dapagliflozin and cardiovascular outcomes in type 2 diabetes. ![]()
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