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Canagliflozin is cardioprotective in diabetic kidney disease

Cardiovascular – October 2019 digest

CREDENCE: Primary and secondary prevention of cardiovascular events in patients type 2 diabetes with chronic kidney disease.

Mahaffey KW, Jardine MJ, Bompoint S et al (2019) Canagliflozin and Cardiovascular and Renal Outcomes in Type 2 Diabetes and Chronic Kidney Disease in Primary and Secondary Cardiovascular Prevention Groups: Results from the Randomized CREDENCE Trial. Circulation 140: 739–50

  • The risks of stroke, myocardial infarction and cardiovascular (CV) death are increased in people with type 2 diabetes with chronic kidney disease. The Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation (CREDENCE) trial demonstrated that canagliflozin reduces the risk of CV and renal outcomes in this group of patients.
  • In this paper, researchers analysed the CV outcomes (CV death, myocardial infarction, stroke, hospitalisation for heart failure or unstable angina) and characteristics of the 4,401 CREDENCE participants with and without CV disease.
  • When compared with those receiving secondary prevention, primary prevention participants were younger, had a shorter duration of diabetes and were more likely to be female.
  • Canagliflozin reduced the risk of major adverse CV events in the primary and secondary prevention arms of the study when compared to placebo (P=0.01). The effects of canagliflozin on stroke, myocardial infarction and CV death were similar.
  • There were consistent reductions in the composite renal outcome (end-stage kidney disease, doubling of serum creatinine and renal or CV death) and composite of CV death or hospitalisation for heart failure in the primary and secondary prevention groups.
  • Researchers concluded that the addition of canagliflozin to standard of care consistently reduced CV and renal outcomes in patients with and without previous CV disease with no increase in the risk of amputation or fracture.

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