期刊
DIABETES OBESITY & METABOLISM
卷 23, 期 10, 页码 2207-2214出版社
WILEY
DOI: 10.1111/dom.14437
关键词
cardiovascular disease; clinical trial; dapagliflozin; diabetes complications; dipeptidyl peptidase-4 inhibitor; heart failure
资金
- AstraZeneca
- National Institute for Health Research (NIHR) Applied Research Collaboration East Midlands (ARC EM)
- NIHR Leicester Biomedical Research Centre (BRC)
- NIHR Nottingham Biomedical Research Centre
- NIHR Nottingham Clinical Research Facilities
- NIHR
- British Medical Association
- UK Research and Innovation
- Innovative Medicines Initiative-2 (BigData@Heart Consortium by the European Union's Horizon 2020 research and innovation programme) [116074]
- Innovative Medicines Initiative-2 (BigData@Heart Consortium by the EFPIA) [116074]
The study found that in patients with type 2 diabetes, sodium-glucose co-transporter-2 inhibitors (SGLT2is) were associated with significantly lower risk of all-cause mortality, cardiovascular death, and hospitalization for heart failure or chronic kidney disease compared to dipeptidyl peptidase-4 inhibitors (DPP4is).
Aim To assess if sodium-glucose co-transporter-2 inhibitors (SGLT2is) reduce the risk of all-cause mortality, cardiovascular death and hospitalization for heart failure (HF) or chronic kidney disease (CKD) to a greater extent than dipeptidyl peptidase-4 inhibitors (DPP4is) in people with type 2 diabetes (T2D) with or without established cardiovascular and/or renal disease (CVRD). Methods This retrospective cohort study propensity-matched 24 438 patients receiving an SGLT2i 1:1 to a patient receiving a DDP4i, stratified based on the presence of CVRD. The primary outcomes were the time to each of the following: all-cause mortality, cardiovascular death or hospitalization for HF, myocardial infarction, stroke and CKD. Results Overall, SGLT2is were associated with reductions in all-cause mortality, cardiovascular mortality, hospitalization for HF and hospitalization for CKD compared with DPP4is. In patients with no CVRD history, SGLT2is were associated with reductions in all-cause mortality (HR 0.71, 95% CI 0.57-0.88; P = .002), hospitalization for HF (HR 0.76, 95% CI 0.59-0.98; P = .035) and hospitalization for CKD (HR 0.75, 95% CI 0.63-0.88; P < .001). In patients with established cardiovascular disease (CVD) or at high risk, SGLT2is were associated with reductions in all-cause mortality (HR 0.69, 95% CI 0.59-0.82; P < .001), cardiovascular mortality (HR 0.76, 95% CI 0.62-0.95; P = .014), hospitalization for HF (HR 0.73, 95% CI 0.63-0.85; P < .001), hospitalization for stroke (HR 0.75, 95% CI 0.59-0.94; P = .013) and hospitalization for CKD (HR 0.49, 95% CI 0.43-0.54; P < .001). Conclusion There was consistency across subgroups and sensitivity analyses. SGLT2is were associated with a reduced risk of all-cause mortality and hospitalization for HF and CKD compared with DPP4-is, highlighting the need to introduce SGLT2is early in the management of patients with T2D.
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