Background: Reduction in cardiovascular death and hospitalization for heart failure (HHF) was recently reported with a sodium-glucose co-transporter-2 inhibitor (SGLT-2i) in Type 2 diabetes patients with cardiovascular disease. We compared HHF and death in new users of SGLT-2i versus other glucose lowering drugs (oGLDs) in six countries to determine if these benefits are seen in real-world practice, and across SGLT-2i class.
Methods: Data were collected via medical claims, primary care/hospital records and national registries. Propensity score for SGLT-2i initiation was used to match treatment groups. Hazard ratios (HRs) for HHF, death and a combined endpoint of HHF or death were estimated by country and pooled to determine weighted effect size.
Results: After propensity matching, there were 309,056 patients newly initiated on either SGLT-2i or oGLD (154,528 patients in each treatment group). Canagliflozin, dapagliflozin, and empagliflozin accounted for 53%, 42% and 5% of the total exposure time in the SGLT-2i class, respectively. Baseline characteristics were balanced between the two groups. There were 961 HHF cases among 309,056 patients with 190,164 person-years follow up (incidence rate [IR] 0.51/100 person-years). Of 215,622 patients in the US, Norway, Denmark, Sweden, and UK, death occurred in 1334 (IR 0.87/100 person-years), and HHF or death in 1983 (IR 1.38/100 person-years). Use of SGLT-2i, versus oGLDs, was associated with significantly lower rates of HHF (HR 0.61; 95% CI 0.51–0.73; p<0.001); death (HR 0.49; 95% CI 0.41–0.57; p<0.001); and HHF or death (HR 0.54; 95% CI 0.48–0.60, p<0.001) with no significant heterogeneity by country.
Conclusions: Treatment with SGLT-2i versus oGLDs in this large international study was associated with a significantly lower risk of HHF and death, suggesting a class effect applicable to a broad population of T2D patients in real-world clinical practice.