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Heart failure and death in new users of SGLT2 inhibitors with and without CVDq

In the CVD-REAL (The Comparative Effectiveness of Cardiovascular Outcomes) study, discussed at the American Diabetes Association 77th Scientific Sessions, initiation of an SGLT2 inhibitor was associated with a significant reduction in death and HF/HHF over the ensuing 8 months compared to use of other oral glucose-lowering drugs, both in people with and without established CVD at initiation (Cavender, 2017).

By Pam Brown, GP and Editor-in-Chief of Diabetes & Primary Care


In those with pre-existing CVD, there was a 31% reduction in HF/HHF (2.2 HF events/100 patient years compared with 3.4/100 patient years) associated with SGLT2 inhibitor initiation versus other oral glucose-lowering drugs (HR 0.69, 95% CI 0.59–0.80), and a 53% mortality rate reduction (1.4 per 100 patient years in those on SGLT2 inhibitors, compared to 3.5 per 100 patient years on other oral glycaemic drugs [HR 0.47 95% CI 0.36–0.61]). In those without CVD at initiation, mortality was 0.4/100 patient years in those initiated on SGLT2 inhibitors, compared with 0.8% in those on other oral glucose-lowering drugs, HR 0.54 (CI 0.44–0.66). Only around 13% of those initiated on SGLT2 inhibitors in this study had established CVD, and in this group, as expected, absolute mortality and HF rates were higher than in those without CVD, resulting in a lower number needed to treat.

This observational, registry-based study of people with T2D newly initiated on SGLT2 inhibitors (canagliflozin 53%, dapagliflozin 42%, empagliflozin 5% total exposure time), propensity matched with people initiated on other oral glucose-lowering drugs, extracted data on more than 300,000 people from registries in five countries, including the Clinical Practice Research Datalink (CPRD) and Health Improvement Network (THIN) in the UK. 

Individual country data reflected the varying use of the different drugs in the class and there was no evidence of heterogeneity between the different drugs. “These data suggest that a broad group of patients with T2D, with and without CVD, may benefit from treatment with this class of drugs”, according to Matthew Cavender, who presented the data on behalf of the study group. However, he stressed that data from ongoing randomised trials will provide further evidence of individual drugs in different populations, some of which are already published. 

These findings build on the previously published data on HHF and all-cause mortality from the same study population (Kosiborod et al, 2017).


Cavender MA (2017) Hospitalization for heart failure and death in new users of SGLT2 inhibitors in patients with and without cardiovascular disease – CVD-REAL study. Oral presentation at the American Diabetes Association 77th Scientific Sessions, San Diego, USA, June 9–13 2017

Kosiborod M et al (2017) Circulation doi: 10.1161/circulationaha.117.029190


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