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SGLT2 inhibitors cut death rates in real-world analysis

Real-world evidence from an international study of more than 300 000 people with type 2 diabetes suggests that treatment with sodium–glucose cotransporter 2 (SGLT2) inhibitors reduced all-cause mortality rates by 51% and risk of hospitalisation for heart failure by 39%. The data, presented at the American College of Cardiology conference on 19 March, suggest that the positive outcomes observed with empagliflozin in the EMPA-REG OUTCOME study are a class effect. The majority of people in the analysis received either dapagliflozin or canagliflozin. Interestingly, the analysis included people at varying risk of heart failure, unlike EMPA-REG, which only included people at high risk. The beneficial effects of SGLT2 inhibitor treatment were observed at all levels of risk.

In the study, titled CVD-REAL, 364 828 people were evaluated using records from hospitals in Sweden, Norway, Denmark, Germany, the UK and the US. The primary endpoint, hospitalisation for heart failure, occurred in 961 people, with a hazard ratio of 0.61 (P<0.001) in SGLT2 inhibitor recipients. There were 1334 deaths from any cause, with a hazard ratio of 0.49 (P<0.001) in the SGLT2 group. There were no signs of significant heterogeneity across the countries, despite variations in demographics and prescribing practice between countries, suggesting that the cardiovascular benefits were likely to be a class effect.

The study, which was sponsored by AstraZeneca, the manufacturer of dapagliflozin, bodes well for the upcoming cardiovascular safety studies of canagliflozin (CANVAS, results of which are due to be published later in 2017) and dapagliflozin (DECLARE, due in 2019).

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