Cardiovascular Benefit of SGLT2 Inhibitors Confirmed
The cardiovascular (CV) benefit of SGLT2 inhibitors in type 2 diabetics, demonstrated by empagliflozin in the EMPA-REG OUTCOME study, has also been confirmed by studies with canagliflozin (CANVAS), a new analysis of the CVD REAL study involving empagliflozin, canagliflozin, and dapagliflozin, as well as individual sub-studies of the EMPA-REG OUTCOME study. These findings, presented in June 2017 at the American Diabetes Association (ADA) congress, are summarized in a recently published article in the journal Critical Pathways in Cardiology.
Introduction
Sodium-glucose cotransporter 2 (SGLT2) inhibitors are among the novel classes of antidiabetics. Due to their unique mechanism of action, they can potentially offer benefits beyond glycemic control. The improvement in CV outcomes was first demonstrated in the EMPA-REG OUTCOME study with empagliflozin. Following the publication of this significant work, several studies were conducted to assess whether the CV and renal benefits of empagliflozin are common to all SGLT2 inhibitors.
CANVAS Program
The presented results of the CANVAS program (CANagliflozin cardioVascular Assessment Study), which includes two large studies with canagliflozin involving more than 10,000 diabetics with high CV risk, showed a lower occurrence of the composite CV endpoint (CV mortality, nonfatal myocardial infarction, and nonfatal stroke) with SGLT2 inhibition compared to placebo (superiority analysis; p = 0.0158) and potential renal benefits of this treatment.
CVD-REAL Study Analyses
The favorable CV effects of SGLT2 inhibitors were also confirmed by new analyses of the CVD-REAL study (Comparative Effectiveness of Cardiovascular Outcomes), which evaluated empagliflozin, canagliflozin, and dapagliflozin in a broader population of type 2 diabetics. In the evaluation of the entire study population, patients newly initiated on SGLT2 inhibitors exhibited a significantly lower CV mortality and overall mortality by 51% (p < 0.01) compared to other antidiabetics. Regardless of the presence of CV disease, there was also a decrease in the incidence of hospitalizations for heart failure (by 39%; p < 0.001). These results were similar in the newly performed analyses of data obtained in the CVD-REAL study.
EMPA-REG OUTCOME Sub-studies
Further reassurance was provided by sub-studies of the EMPA-REG OUTCOME study, which confirmed the benefit of empagliflozin across individual patient categories, adjusted for blood pressure control, LDL cholesterol level, and glycated hemoglobin level over time. It was shown that these parameters do not affect the assessed efficacy of empagliflozin.
(zza)
Source: Lee S. Update on SGLT2 inhibitors – new data released at the American Diabetes Association. Crit Pathw Cardiol 2017 Sep; 16 (3): 93–95, doi: 10.1097/HPC.0000000000000125.
Did you like this article? Would you like to comment on it? Write to us. We are interested in your opinion. We will not publish it, but we will gladly answer you.