However, not all SGLT2 inhibitors share the same pharmacokinetic properties for example, dapagliflozin with its slower excretion by the kidney exerts its pharmacological effects longer, even after 18 h post-dose, whereas the effects of empagliflozin are markedly attenuated from 12 h post-dose. SGLT2 inhibitors, in addition to glycemic controls, also have a positive effect on the cardiometabolic markers, such as body weight, blood pressure and uric acid, and as a result there has been increasing use of SGLT2 inhibitors for the management of type 2 diabetes in clinical practice. Although the direct cardioprotective mechanisms are not fully understood, they may be related to hemodynamic and metabolic actions from SGLT2 inhibitors. In addition, compared to incretin-based therapies, including glucagon-like-peptide 1 (GLP-1) agonists and dipeptidyl peptidase 4 (DPP-4) inhibitors, SGLT2 inhibitors are associated with lower risks of all-cause and cardiovascular-specific mortality, and occurrence of heart failure and myocardial infarction. A meta-analysis of three large placebo-controlled cardiovascular outcome trials found that SGLT2 inhibitors reduced major adverse cardiovascular events by 11% (HR: 0.89, 95% CI 0.83–0.96).
Sodium–glucose co-transporter 2 (SGLT2) inhibitor which decreases glucose re-absorption in the kidney and increases excretion via the urine is the new drug class for type 2 diabetes management with favorable safety profiles, and is recommended as an option for treatment intensification after the failure of metformin. Although the largest absolute benefits of interventions for individual patients are achieved among those with established atherosclerotic cardiovascular disease, the large number of type 2 diabetes patients without a history of major cardiovascular disease makes knowledge about the effects of anti-diabetes medication on first events an additional priority. Current medication and lifestyle interventions may not be sufficient to reduce the risk of serious cardiovascular disease outcomes in the primary prevention cohorts of type 2 diabetes. Patients with type 2 diabetes suffer substantial morbidity and mortality from cardiovascular disease. Future prospective studies are required to confirm the findings. The risk of cardiovascular events was similar between dapagliflozin and empagliflozin new users, but dapagliflozin may have a better outcome in the reduction of heart failure in type 2 diabetes patients. Compared to empagliflozin users, new users of dapagliflozin were found to have similar risks for primary composite outcome (adjusted HR: 0.91 95% CI 0.73–1.14), cardiovascular death (adjusted HR: 0.54 95% CI 0.14–2.12), myocardial infarction (adjusted HR: 0.77, 95% CI 0.49–1.19) and ischemic stroke (adjusted HR: 1.15 95% CI 0.80–1.65), but a lower risk of heart failure (adjusted HR: 0.68 95% CI 0.49–0.95). A total of 10,442 person-years of dapagliflozin use and 12,096 person-years of empagliflozin use were included. We identified 12,681 new SGLT2 inhibitor users with a mean age of 58.9 (SD 11.8) years, of whom 43.9% were female and 45.8% were new dapagliflozin users.
We performed multivariable Cox proportional hazard modeling, adjusting for patients’ age, sex, laboratory data, co-morbidities, and concomitant medications. We followed up patients from initiation of SGLT2 inhibitors until the occurrence of cardiovascular events before December 31, 2018. The primary outcome was a composite of cardiovascular death, myocardial infarction, ischemic stroke and heart failure. We conducted a retrospective cohort study by analyzing a multi-institutional electronic medical records database (Chang Gung Research Database) in Taiwan and included adult type 2 diabetes patients who were newly receiving sodium–glucose co-transporter 2 (SGLT2) inhibitors from 2016 to 2017. To compare the cardiovascular event risk in type 2 diabetes patients newly receiving dapagliflozin vs.
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