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New Diabetes Medications Have Reduced Heart Failure Risk by 34 Percent

Oct 8, 2019
 
Editor: David L. Joffe, BSPharm, CDE, FACA

Author: Keri Hames, PharmD Candidate, Florida A&M University, College of Pharmacy & Pharmaceutical Sciences

Which medications are most effective for reduced heart failure risk? Study examines SGLT-2 inhibitors versus DPP-4 in reducing cardiovascular events.

In previous studies, researchers have discovered that sodium glucose cotransporter 2 (SGLT2) inhibitors have reduced the risk of major cardiovascular events, hospital admission for heart failure, and any cause of death. In these studies, they examined patients that had type 2 diabetes and a history of cardiovascular disease or who were at high risk of having a cardiovascular event to understand how SGLT2 inhibitors reduce the risk of cardiovascular endpoints.  The purpose of the current study was to evaluate the risk of cardiovascular events and heart failure in patients who are new users of SGLT2 inhibitors compared to dipeptidyl peptidase 4 (DPP4) inhibitors. 

 

This study took place in three Scandinavian countries (Denmark, Norway, and Sweden) from April 2013 to December 2016.  The researchers in this study evaluated 41,966 subjects within these regions and time period. Half of the subjects (20,983) were new users of SGLT2 inhibitors, whereas the other half of the subjects (20,983) were new users of DPP4 inhibitors.  The mean age of the subjects was 61 years of age, 60% of them were men, and 19% of them had a history of cardiovascular disease. The primary outcome was a composite for major cardiovascular events (i.e., myocardial infarction, stroke, and cardiovascular death) and heart failure (i.e., hospitalization for heart failure or death from heart failure).  The secondary outcomes were the separable components of the composite for the cardiovascular events and death from any cause. 

Most of the patients that were placed on SGLT2 inhibitors were assigned to Farxiga (83%), followed by Jardiance (16%) and Invokana (1%).  The incidence rate of cardiovascular events in the SGLT2 inhibitors was 17 events per 1000 person-years, whereas DPP4 inhibitors’ incidence rate was 18.  Heart failure incidence rate in SGLT2 inhibitors was 4.7 and 7.1 in patients taking DPP4 inhibitors. Hazard ratios for major cardiovascular events was 0.94 (95% CI 0.84 to 1.06) and for heart failure 0.66 (0.53 to 0.81). Hazard ratios for secondary outcomes when comparing SGLT2 inhibitors to DPP4 inhibitors, was 0.80 (0.69 to 0.92) for any cause death, 0.84 (0.65 to 1.08) for cardiovascular death, 0.99 (0.85 to 1.17) for myocardial infarction, 0.94 (0.77 to 1.15) for stroke. 

When comparing this data, it was found that SGLT2 inhibitors had a 34% reduced risk of heart failure and a 20% reduced risk in the secondary outcome of any cause of death.  Most of the benefits from the SGLT2 inhibitors came from Farxiga due to number of patients being on this drug and this drug being the most common SGLT2 inhibitor in Scandinavia during the time of the study. The outcomes for major cardiovascular events were largely affected by a single component, which was cardiovascular death. These results can be applied to the patients within the United States because there are about 5.7 million patients dealing with a combination of heart failure and type 2 diabetes.

Practice Pearls:

  • Previous studies evaluated the risk of SGLT2 inhibitors in patients with type 2 diabetes and who had a history of cardiovascular events, or patients that were at increased risk of cardiovascular outcomes. 
  • When comparing to SGLT2 inhibitors to DPP4 inhibitors, there was a 34% reduction in heart failure and a 20% reduction in any cause of death.
  • Cardiovascular death was the driving component that largely affected the outcome of major cardiovascular death. 

Pasternak, Björn, et al. “Use of Sodium Glucose Cotransporter 2 Inhibitors and Risk of Major Cardiovascular Events and Heart Failure: Scandinavian Register Based Cohort Study.” The BMJ, British Medical Journal Publishing Group, 29 Aug. 2019

Keri Hames, PharmD, Candidate Florida A&M University College of Pharmacy & Pharmaceutical Sciences