SGLT2 inhibitors did not significantly reduce the risk of acute coronary syndrome (RR 0.97), peripheral arterial occlusive disease (RR 0.98), or ischemic stroke (RR 0.95) compared to placebo or oral hypoglycemic drugs in patients with type 2 diabetes.
Meta-Analysis (n=79,504)
Does SGLT2 inhibitor therapy reduce the incidence of acute coronary syndrome, peripheral arterial occlusive disease, or ischemic stroke in patients with type 2 diabetes?
SGLT2 inhibitors do not significantly reduce the incidence of acute coronary syndrome, peripheral arterial occlusive disease, or ischemic stroke in patients with type 2 diabetes, despite reducing cardiovascular and all-cause mortality.
Relative Risk: 0.97 (95% CI 0.89–1.05)
Absolute Event Rate: 3.1% vs 3.45%
BACKGROUND: Patients with type 2 diabetes are at increased risk for cardiovascular diseases. Sodium-glucose transport 2 inhibitors (SGLT2i) have been shown to enhance cardiovascular health since their debut as a second-line therapy for diabetes. Acute coronary syndrome (ACS), peripheral arterial occlusive disease (PAOD), and ischemic stroke (IS) are types of atherosclerotic cardiovascular disease (ASCVD), although the benefits of treating these disorders have not been shown consistently. METHODS: We searched four databases (PubMed, Embase, the Cochrane library, and clinicaltrial.gov) for randomized clinical trials (RCTs) until November of 2022. Comparisons were made between SGLT2i-treated and control individuals with type 2 diabetes. Primary outcomes were ACS, PAOD, and IS; secondary outcomes included cardiovascular mortality and all-cause mortality. Risk ratio (RR) and 95% confidence intervals (CI) were determined using a fixed effects model. Cochrane's risk-of-bias (RoB2) instrument was used to assess the validity of each study that met the inclusion criteria. RESULTS: We enrolled 79,504 patients with type 2 diabetes from 43 RCTs. There was no difference in the risk of ACS (RR = 0.97, 95% CI 0.89-1.05), PAOD (RR = 0.98, 95% CI 0.78-1.24), or IS (RR = 0.95, 95% CI 0.79-1.14) among patients who took an SGLT2i compared to those who took a placebo or oral hypoglycemic drugs. Subgroup analysis revealed that none of the SGLT2i treatments (canagliflozin, dapagliflozin, empagliflozin, and ertugliflozin) significantly altered outcomes when analyzed separately. Consistent with prior findings, SGLT2i reduced the risk of cardiovascular mortality (RR = 0.85, 95% CI 0.77-0.93) and all-cause mortality (RR = 0.88, 95% CI 0.82-0.94). CONCLUSION: Our results appear to contradict the mainstream concepts regarding the cardiovascular effects of SGLT2i since we found no significant therapeutic benefits in SGLT2i to reduce the incidence of ACS, PAOD, or IS when compared to placebo or oral hypoglycemic drugs.
Tsai et al. (Mon,) ont réalisé une méta-analyse chez des patients atteints de diabète de type 2 (n=79 504). L'évaluation des inhibiteurs de SGLT2 par rapport au placebo ou aux médicaments hypoglycémiants oraux a été réalisée sur le syndrome coronarien aigu (SCA) (RR 0,97, IC 95 % 0,89-1,05). Les inhibiteurs de SGLT2 n'ont pas réduit de manière significative le risque de syndrome coronarien aigu (RR 0,97), de maladie artérielle périphérique occlusive (RR 0,98) ou d'accident vasculaire cérébral ischémique (RR 0,95) par rapport au placebo ou aux médicaments hypoglycémiants oraux chez les patients atteints de diabète de type 2.