Canagliflozin effective in primary and secondary prevention of CV outcomes

Mahaffey KW, Jardine MJ, Bompoint S et al (2019) Canagliflozin and cardiovascular and renal outcomes in type 2 diabetes mellitus and chronic kidney disease in primary and secondary cardiovascular prevention groups: Results from the randomized CREDENCE trial. Circulation 140: 739–50

• Individuals with type 2 diabetes and chronic kidney disease have an increased risk of cardiovascular disease. SGLT-2 inhibitors reduce the risk of kidney failure in these patients but their effects on different cardiovascular outcomes and primary prevention were unclear.
• The Evaluation of the Effects of Canagliflozin on Renal and Cardiovascular Outcomes in Participants with Diabetic Nephropathy (CREDENCE) study demonstrated that the addition of canagliflozin to standard care prevented cardiovascular and renal outcomes. In this paper, investigators analysed individual cardiovascular outcomes for participants with and without cardiovascular disease (CVD).
• Of the 4,401 CREDENCE participants, 2,181 had no history of CVD at enrolment. When compared to the 2,220 secondary prevention participants, on average individuals without CVD had a 1-year shorter history of diabetes and were 4 years younger. A higher proportion of primary prevention participants were female.
• Treatment with canagliflozin resulted in consistent and significant reductions in the risk of major cardiovascular events in both the primary and secondary prevention groups. When split into individual components, the reductions in cardiovascular death, non-fatal stroke, non-fatal myocardial infarction and hospitalisation for heart failure were similar in both groups.
• The risk of renal outcomes (end-stage kidney disease, doubling of serum creatine, or renal or cardiovascular death) was similarly reduced in the primary and secondary prevention groups.
• Investigators concluded that in patients with type 2 diabetes and chronic kidney disease, canagliflozin results in robust and consistent reductions in cardiovascular and renal outcomes when used for primary and secondary prevention. 

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