Author + information
- Carolyn S.P. Lam,
- Avraham Karasik,
- Matthew Cavender,
- Shun Kohsaka,
- Anna Norhammar,
- Marcus Thuresson,
- Hungta Chen,
- Eric Wittbrodt,
- Peter Fenici and
- Mikhail Kosiborod
Randomized trials and real world analyses showed lower risks of heart failure hospitalization (HHF) or death with sodium glucose cotransporter-2 inhibitors (SGLT2i) in patients with type 2 diabetes (T2D); however, no information on baseline left ventricular ejection fraction (EF) was available in the prior studies.
We compared the risk of HHF or death in patients starting SGLT2i vs other glucose lowering drugs (OGLD) with available baseline EF measurements, using real world data from the Maccabi database in Israel. Propensity scores for SGLT2i initiation were developed separately for each baseline EF strata (≤40% vs >40%) with 1:1 matching.
After propensity-match, there were 13126 episodes of treatment initiation (6563 in each group); mean diabetes duration was 11 yrs, mean HbA1c 8.1%, 44% had established CVD, 7% had HF, and 20% CKD (stage 3 or worse). Overall, 528 patients (4%) had EF ≤40%, and 1190 (9%) had EF ≤50%. In the SGLT-2i group, 37% of treatment episodes were with dapagliflozin, and 63% with empagliflozin. In the OGLD group, 29% of treatment episodes were with DPP4 inhibitors, 17% with GLP1 receptor agonists, 14% with metformin, 11% with insulin, 10% with sulfonylureas, 7% with TZDs, and the rest with other agents. Mean duration of follow-up was 1.5 years. There were 432 HHF or death events, of which 71 (16.4%) occurred in patients with EF ≤40%. Initiation of SGLT2i vs OGLD was associated with significantly lower risk of HHF or death (HR 0.54, 95%CI 0.44-0.65, P<0.001); both in patients with EF ≤40% (HR 0.50, 95%CI 0.32-0.78) and >40% (HR 0.53; 95% CI 0.43-0.66). Use of SGLT2i vs OGLD was also associated with lower risk of HHF (HR 0.59, 95%CI 0.49-0.77) and death (HR 0.51, 95%CI 0.40-0.65; P≤0.001 for all); with no heterogeneity between EF subgroups. Effects were consistent when EF was dichotomized as ≤ vs >50%, as well as when restricting analyses to those with a history of HF.
Our findings from real world clinical practice indicate that lower risk of HHF and death associated with use of SGLT2i vs other agents is consistent in T2D patients with both reduced and preserved EF; and suggest that HF prevention benefits of SGLT2i may extend across the range of baseline EF.
Moderated Poster Contributions
Prevention Moderated Poster Theater, Poster Hall, Hall F
Sunday, March 17, 2019, 10:15 a.m.-10:25 a.m.
Session Title: Novel Diabetes Agents and Cardiovascular Outcomes
Abstract Category: 32. Prevention: Clinical
Presentation Number: 1024-07
- 2019 American College of Cardiology Foundation