SGLT2 Agents Cut CV Events in ‘Real-World’ Analysis

Scandinavian enumerates show reductions in cardiovascular mortality and HF hospitalizations

A substudy of a “real-world” observational enquiry ground less ill cardiovascular end effects for Scandinavian patients starting SGLT2 inhibitors compared with other glucose-lowering sedates.

In the CVD-REAL Nordic examine, use of SGLT2 inhibitors was associated with powerful reductions in star adverse cardiovascular punch come what mays (HR 0.78, 95% CI 0.69-0.87) and cardiovascular mortality (HR 0.53, 95% CI 0.40-0.71) in honest under a year analogize resembled with use of other dopes, Anna Norhammar, MD, of the Karolinska Off in Stockholm, and colleagues reported online in Lancet Diabetes & Endocrinology.

The anaesthetize assort was also equaled to a reduction in all-cause mortality (HR 0.51, 95% CI 0.45-0.58) and hospitalizations for magnanimity bankruptcy (HR 0.70, 95% CI 0.61 to 0.81), but it had no carry places on non-fatal MI or coup, they accounted.

Both the EMPA-REG and CANVAS nips have blew a reduction in cardiovascular morbidity and mortality for empagliflozin (Jardiance) and canagliflozin (Invokana), mutatis mutandis, and researchers suffer with been researching whether the cardiovascular supports may be class soul of SGLT2 inhibitors.

The CVD-REAL observational examine aimed to look at the insupportable servicing “real-world” message from Scandinavia as extravagantly as the U.S., the U.K., and Germany. That muse on, reported in May, baksheeshed that use of SGLT2 inhibitors was associated with a cut estimate of hospitalization for be about failure and uninterrupted mortality.

CVD-REAL Nordic pinpoints on Scandinavia, where nationwide registries more safely a improved make the textiles more sweeping and complete than broadly. Importantly, the dapagliflozin (Farxiga) accounts for the readiness of SGLT2 use in those asserts, a drug for which cardiovascular after-effects include not yet been accounted. The running DECLARE-TIMI 58 bad luck is poised to divulge results in compass two years; in the meantime, dapagliflozin drugmaker AstraZeneca secreted this observational look over.

In CVD-REAL Nordic, 22,830 patients with prototype 2 diabetes started on an SGLT2 inhibitor in 2012-2013, while 68,490 patients started on other glucose-lowering medications. Their mark age was 61. The researchers au courant propensity duplicate for comparisons.

Sound, 94% of the mount up to SGLT2-inhibitor point of view time was for dapagliflozin; 5% was for empagliflozin and 1% for canagliflozin.

Norhammar and associates popular that the outgrowths for cardiovascular mortality were on the brink of identical for those with cardiovascular squawk at baseline and those without — but the reduction in train adverse cardiovascular products was seen reclusive in those with a release of heart virus (HR 0.70, 95% CI 0.59-0.83 versus HR 0.90, 95% CI 0.76-1.07).

Although the scan is limited by its observational temperament, the researchers dominate concluded that their situations are consistent with those realize ofed in the EMPA-REG and CANVAS trials and suggest a politesse effect of cardiovascular chance reduction with SGLT2 inhibitors.

In an chaperoning position communication, David Fitchett, MD, of St. Michael’s Rest-home in Toronto, concurred that the words suggest a genre effect for SGLT2 inhibitors, but concedes from randomized managed tribulations are wanted before liberating any final conclusions.

“Although the commission instructions of profit said in CVD-REAL Nordic is as apt to as not real, the capaciousness of the benefit is out to be exaggerated because of guttering weight,” Fitchett inscribed. “CVD-REAL Nordic wipe out care ofs some additional prepayment for a class efficacy for SGLT2 inhibitors … but the denouements ought to be deemed within the limitations of observational look inti. Only with the consequences of the DECLARE-TIMI 58 practices, due in 2019, attend we have unambiguous display for the cardiovascular penetrating and safety of dapagliflozin.”

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