Comparison of cardiovascular outcomes between SGLT2 inhibitors in diabetes mellitus

Abstract

Background There have been scarce data comparing cardiovascular outcomes between individual sodium-glucose cotransporter-2 (SGLT2) inhibitors. We aimed to compare the subsequent cardiovascular risk between individual SGLT2 inhibitors. Methods We analyzed 25,315 patients with diabetes mellitus (DM) newly taking SGLT2 inhibitors (empagliflozin: 5302, dapagliflozin: 4681, canagliflozin: 4411, other SGLT2 inhibitors: 10,921). We compared the risks of developing heart failure (HF), myocardial infarction (MI), angina pectoris (AP), stroke, and atrial fibrillation (AF) between individual SGLT2 inhibitors. Results Median age was 52 years, and 82.5% were men. The median fasting plasma glucose and HbA1c levels were 149 (Q1-Q3:127–182) mg/dL and 7.5 (Q1-Q3:6.9–8.6) %. During a mean follow-up of 814 ± 591 days, 855 HF, 143 MI, 815 AP, 340 stroke, and 139 AF events were recorded. Compared with empagliflozin, the risk of developing HF, MI, AP, stroke, and AF was not significantly different in dapagliflozin, canagliflozin, and other SGLT inhibitors. For developing HF, compared with empagliflozin, hazard ratios of dapagliflozin, canagliflozin, and other SGLT2 inhibitors were 1.02 (95% confidence interval [CI] 0.81–1.27), 1.08 (95% CI 0.87–1.35), and 0.88 (95% CI 0.73–1.07), respectively. Wald tests showed that there was no significant difference in the risk of developing HF, MI, AP, stroke, and AF among individual SGLT2 inhibitors. We confirmed the robustness of these results through a multitude of sensitivity analyses. Conclusion The risks for subsequent development of HF, MI, AP, stroke, and AF were comparable between individual SGLT2 inhibitors. This is the first study comparing the wide-range cardiovascular outcomes of patients with DM treated with individual SGLT2 inhibitors using large-scale real-world data.

Comparison of Cardiovascular Outcomes Between Dapagliflozin and Empagliflozin in Patients With Type 2 Diabetes: A Meta-Analysis

“…After removing duplicates, the title and abstracts of 207 articles were screened based on inclusion criteria. Overall, 22 articles were eligible for full-text screening, and finally, four studies were included in this meta-analysis [11][12][13][14]. The PRISMA flow chart is shown in Figure 1.…”

“…Overall, four studies compared the risk of myocardial infarction between two groups [11][12][13][14]. In patients with type 2 diabetes, the risk of MI was not significantly different between patients who received dapagliflozin and patients who received empagliflozin (risk ratio (RR)=0.81, 95% confidence interval (CI): 0.60-1.09).…”

“…Sources: References 11-14 [11][12][13][14] Four studies were analyzed to assess the effects of dapagliflozin and empagliflozin on the risk of heart failure in patients with type 2 diabetes [11][12][13][14]. No significant difference in risk of heart failure was there between dapagliflozin and empagliflozin (RR=0.76, 95% CI: 0.56-1.04).…”

“…Sources: References 11-13 [11][12][13] Three studies were employed to compare the effects of dapagliflozin and empagliflozin on the risk of stroke [11,[13][14]. The risk of stroke was not significantly different in type 2 diabetic patients who received dapagliflozin and who received empagliflozin (RR=1.07, 95% CI: 0.84-1.38).…”

“…The diamonds signify the pooled RR; the diamond's center denotes the point estimate and the width denotes the 95% CI. CI: confidence interval; RR: risk ratio Sources: References 11-14[11][12][13][14]…”