Key result
SGLT2 inhibitors linked to ~27% lower risk of new-onset heart failure versus DPP-4 inhibitors.
Why the study?
SGLT2I and DPP4I are increasingly prescribed for type 2 diabetes mellitus, but few population-based studies have compared their effects on incident heart failure or myocardial infarction.
Do SGLT2 inhibitors reduce incident heart failure, myocardial infarction, and mortality compared to DPP4 inhibitors in patients with type 2 diabetes mellitus?
Cohort (n=41,994)
Yes
Do SGLT2 inhibitors reduce incident heart failure, myocardial infarction, and mortality compared to DPP4 inhibitors in patients with type 2 diabetes mellitus?
Hazard Ratio: 0.73 (95% CI 0.66–0.81)
Absolute Event Rate: 3.03% vs 5.57%
p-value: p=<0.0001
In a large Chinese cohort of patients with type 2 diabetes, SGLT2 inhibitors were associated with significantly lower risks of incident heart failure, myocardial infarction, and mortality compared to DPP4 inhibitors.
AIMS: This study aimed to compare the rates of major cardiovascular adverse events in sodium-glucose cotransporter-2 inhibitors (SGLT2I) and dipeptidyl peptidase-4 inhibitors (DPP4I) users in a Chinese population. SGLT2I and DPP4I are increasingly prescribed for type 2 diabetes mellitus patients. However, few population-based studies are comparing their effects on incident heart failure or myocardial infarction. METHODS AND RESULTS: This was a population-based retrospective cohort study using the electronic health record database in Hong Kong, including type 2 diabetes mellitus patients receiving either SGLT2I or DPP4I from 1 January 2015 to 31 December 2020. Propensity score matching was performed in a 1:1 ratio based on demographics, past comorbidities, and non-SGLT2I/DPP4I medications with nearest neighbour matching (caliper = 0.1). Univariable and multivariable Cox models were used to identify significant predictors for new-onset heart failure, new-onset myocardial infarction, cardiovascular mortality, and all-cause mortality. Sensitivity analyses with competing risk models and multiple propensity score matching approaches were conducted. A total of 41 994 patients (58.89% males, median admission age at 58 years old, interquartile range [IQR]: 51.2-65.3) were included with a median follow-up of 5.6 years (IQR: 5.32-5.82). In the matched cohort, SGLT2I use was significantly associated with lower risks of new-onset heart failure (hazard ratio [HR]: 0.73, 95% confidence interval [CI]: [0.66, 0.81], P < 0.0001), myocardial infarction (HR: 0.81, 95% CI: [0.73, 0.90], P < 0.0001), cardiovascular mortality (HR: 0.67, 95% CI: [0.53, 0.84], P < 0.001), and all-cause mortality (HR: 0.26, 95% CI: [0.24, 0.29], P < 0.0001) after adjusting for significant demographics, past comorbidities, and non-SGLT2I/DPP4I medications. CONCLUSIONS: SGLT2 inhibitors are protective against adverse cardiovascular events including new-onset heart failure, myocardial infarction, cardiovascular mortality, and all-cause mortality. The prescription of SGLT2I is preferred when taken into consideration individual cardiovascular and metabolic risk profiles in addition to drug-drug interactions.
No takes yet. Share an insight, caveat, or question.
Zhou et al. (2022) conducted a cohort in Type 2 diabetes mellitus (n=41,994). Sodium-glucose cotransporter-2 inhibitors (SGLT2I) vs. Dipeptidyl peptidase-4 inhibitors (DPP4I) was evaluated on New-onset heart failure (HR 0.73, 95% CI 0.66, 0.81, p=<0.0001). SGLT2 inhibitors were associated with lower risks of new-onset heart failure (HR 0.73) and myocardial infarction (HR 0.81) compared to DPP-4 inhibitors in patients with type 2 diabetes.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: