July 22, 2026Open Access
Cardiovascular Effects of Canagliflozin in Relation to Renal Function and Albuminuria
Key Result
Canagliflozin significantly reduced cardiovascular death or hospitalization for heart failure compared with placebo (19.4 vs 28.0 events per 1,000 patient-years; HR 0.70; 95% CI 0.62-0.79).
Key Points
- This study aims to assess how canagliflozin affects cardiovascular outcomes based on renal function and albuminuria levels.
- Pooled patient-level data from CANVAS Program and CREDENCE trial were analyzed.
- Subgroups based on eGFR and UACR were assessed for cardiovascular outcomes.
- Cox regression models estimated hazard ratios (HRs) and 95% confidence intervals (CIs).
- Canagliflozin reduced cardiovascular death or hospitalization for heart failure (19.4 vs 28.0 events per 1,000 patient-years; HR: 0.70; 95% CI: 0.62-0.79).
- Rates of cardiovascular death and hospitalization increased with decreasing eGFR and increasing UACR.
- The results were consistent across different categories of renal function and albuminuria.
Study Design
Type
Meta-Analysis
Multicenter
Yes
Structured PICO
Does canagliflozin reduce cardiovascular death or heart failure hospitalization in patients with T2DM and high cardiovascular risk or nephropathy across different levels of baseline renal function and albuminuria?
P
Population
Patients with type 2 diabetes mellitus and high cardiovascular risk or nephropathy.
I
Intervention
Canagliflozin
C
Comparator
Placebo
O
Outcome
Composite of cardiovascular death or hospitalization for heart failure (HHF)composite
Canagliflozin consistently reduces the risk of cardiovascular death or heart failure hospitalization in patients with T2DM and high cardiovascular risk or nephropathy, regardless of baseline renal function or albuminuria.
Main Result
Hazard Ratio: 0.7 (95% CI 0.62–0.79)
Absolute Event Rate: 19.4% vs 28%
Abstract
BACKGROUND: People with type 2 diabetes mellitus (T2DM) have elevated cardiovascular (CV) risk, including for hospitalization for heart failure (HHF). Canagliflozin reduced CV and kidney events in patients with T2DM and high CV risk or nephropathy in the CANVAS (CANagliflozin cardioVascular Assessment Study) Program and the CREDENCE (Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation) trial. OBJECTIVES: The aim of this study was to assess the effects of canagliflozin on CV outcomes according to baseline estimated glomerular filtration rate (eGFR) and urine albumin:creatinine ratio (UACR) in pooled patient-level data from the CANVAS Program and CREDENCE trial. METHODS: ) and UACR (300 mg/g). HRs and 95% CIs were estimated by using Cox regression models overall and according to subgroups. RESULTS: , and 31.9% with UACR >300 mg/g. Rates of CV death or HHF increased as eGFR declined and/or UACR increased. Canagliflozin significantly reduced CV death or HHF compared with placebo (19.4 vs 28.0 events per 1,000 patient-years; HR: 0.70; 95% CI: 0.62-0.79), with consistent results across eGFR and UACR categories (all P interaction >0.40). CONCLUSIONS: Risk of CV death or HHF was higher in those with lower baseline eGFR and/or higher UACR. Canagliflozin consistently reduced CV death or HHF in participants with T2DM and high CV risk or nephropathy regardless of baseline renal function or level of albuminuria. (Canagliflozin Cardiovascular Assessment Study CANVAS, NCT01032629; A Study of the Effects of Canagliflozin JNJ-24831754 on Renal Endpoints in Adult Participants With Type 2 Diabetes Mellitus CANVAS-R, NCT01989754; and Evaluation of the Effects of Canagliflozin on Renal and Cardiovascular Outcomes in Participants With Diabetic Nephropathy CREDENCE, NCT02065791).
Expert Takes2 quotes
1/2
“Most interestingly, the three other cardiovascular risk markers show no difference in the effect of canagliflozin when we compare them for the four different eGFR groups. Reductions in systolic blood pressure, body weight, and albuminuria were very consistent across the groups.”
Dick de Zeeuw, Nephrologist, University Medical Center GroningenUniversity Medical Center Groningenauto_pipelineView source
Cite This Study
Sarraju et al. (Mon,) conducted a meta-analysis in Type 2 diabetes mellitus with high cardiovascular risk or nephropathy. Canagliflozin vs. Placebo was evaluated on Cardiovascular death or hospitalization for heart failure (HHF) (HR 0.70, 95% CI 0.62-0.79). Canagliflozin significantly reduced cardiovascular death or hospitalization for heart failure compared with placebo (19.4 vs 28.0 events per 1,000 patient-years; HR 0.70; 95% CI 0.62-0.79).