SGLT2s cut cardiac risk for most with T2D

3 minute read

More patients get cardiac benefits from the drugs than previously thought.

Sodium glucose co-transporter 2 (SGLT2) inhibitors reduce the risk of major adverse cardiovascular events, research suggests, as Australian experts say they should be offered to most people with type 2 diabetes. 

The study, presented at the American College of Cardiology Annual Scientific Session and Expo and published in Circulation, found that SGLT2i had reduced cardiac events in patients with and without cardiovascular disease and diabetes, and across a wide range of kidney function, including patients with advanced chronic kidney disease. 

The international researchers found the benefit of SGLT2 inhibitors lay mainly in the reduced risk of heart failure and sudden cardiac death. They did not find a significant effect of SGLT2 inhibitors on rates of myocardial infarction (which was 5% lower) and no effect on the risk of stroke. 

The meta-analysis included more than 78,000 participants in 11 phase III randomised placebo-controlled trials of SGLT2 inhibitors. The studies included three different patient populations: those with diabetes at high risk for atherosclerotic cardiovascular disease, patients with heart failure and patients with chronic kidney disease. 

The researchers found that SGLT2 inhibitors reduced the rate of major adverse cardiovascular events by 9% among all three patient populations, and the effect was mainly driven by a reduction in cardiovascular death, particularly heart failure and sudden cardiac death. 

That effect “was generally consistent across patient populations including those with or without established ASCVD, diabetes or heart failure at baseline, and across a wide range of kidney function”, they said. 

While previous studies had shown a reduction in heart failure risk and kidney outcomes with SGLT2 inhibitors, the effect of the drugs on major adverse cardiovascular events had been unclear. 

“These data provide a comprehensive overview of the anticipated treatment effects of SGLT2i across a wide range of patient populations and may help inform selection of SGLT2i therapies in patients encountered in clinical practice,” the authors said. 

Co-author and nephrologist Dr Brendon Neuen, from Sydney’s Royal North Shore Hospital and The George Institute for Global Health, said the findings indicated that SGLT2 inhibitors should be offered to most people with type 2 diabetes to reduce the risk of cardiovascular events. 

“The consistent effects – regardless of prior cardiovascular disease – indicate that SGLT2 inhibitors should be widely offered to patients with type 2 diabetes, irrespective of whether they have established cardiovascular disease or not,” he told TMR

“The data should engender greater confidence among GPs that this class of agent has broad benefits on cardiovascular outcomes – including death due to cardiovascular disease – across many different types of patients that are likely to be encountered in clinical practice.” 

Dr Neuen said the data gave more “granularity” on the types of cardiovascular events prevented by SGLT2 inhibitors. 

“While SGLT2 inhibitors reduce death due to cardiovascular disease by about 15%, they do not appear to reduce myocardial infarction or stroke,” said Dr Neuen, co-chair of the SGLT2 Meta-Analysis Cardio-Renal Trialists Consortium (SMART-C). 

“The reduction in cardiovascular death is driven by reductions in heart failure and sudden cardiac death. This is important because other medicines, such as GLP-1 RAs, reduce myocardial infarction and stroke, but perhaps have less prominent effects on heart failure.  

“Using them in combination is inherently attractive from a cardiovascular viewpoint, as they prevent different types of events.” 

Circulation 2024, online 7 April 

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