Lower heart failure and chronic kidney disease risks associated with sodium‐glucose cotransporter‐2 inhibitor use in Japanese type 2 diabetes patients without established cardiovascular and renal diseases

Apr 9, 2021Diabetes, obesity & metabolism

Lower heart failure and kidney disease risks linked to sodium-glucose transporter-2 inhibitor use in Japanese type 2 diabetes patients without existing heart or kidney problems

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Abstract

A total of 108,362 cardiovascular and renal disease-free patients were analyzed, revealing that SGLT-2 inhibitors are associated with a lower risk of cardiorenal diseases and mortality compared to other glucose-lowering drugs.

SGLT-2 inhibitors may reduce the risk of cardiorenal disease by 45% compared to other glucose-lowering drugs.
The risk of heart failure is reduced by 27% with SGLT-2 inhibitors compared to other treatments.
SGLT-2 inhibitors are associated with a 55% lower risk of chronic kidney disease.
The risk of stroke may be 31% lower for patients using SGLT-2 inhibitors.
All-cause mortality is potentially reduced by 48% in those treated with SGLT-2 inhibitors.

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AIMS: To examine heart failure (HF) and chronic kidney disease (CKD) risks reduction associated with sodium-glucose cotransporter-2 inhibitors (SGLT-2i) compared to other glucose-lowering drugs (oGLD) in the early stage of type 2 diabetes patients without established cardiovascular or renal diseases (CVRD-free T2D).

MATERIALS AND METHODS: We performed an observational cohort study using a Japanese hospital claims registry, Medical Data Vision. CVRD-free T2D patients were identified between 1 April 2014 and 30 September 2018. SGLT-2i and oGLD new users (and dipeptidyl peptidase 4 inhibitors [DPP-4i] separately) were subjected to 1:1 propensity-score matching analysis. Hazard ratios (HRs) of cardiorenal disease (HF and/or CKD), HF, CKD, stroke, myocardial infarction (MI), and all-cause mortality, were estimated using unadjusted Cox regression.

RESULTS: A total of 108 362 CVRD-free patients including 54 181 SGLT-2i and 54 181 oGLD users were matched. Baseline characteristics were well balanced (mean age 59.1 years, 63% male, and follow-up 1.50 years [162 970 patient-years]). Compared to oGLD group, SGLT-2i group had lower risk of cardiorenal disease, HF, CKD, stroke, and all-cause mortality with HRs (95% confidence intervals) 0.55 (0.49-0.61), 0.73 (0.61-0.87), 0.45 (0.39-0.52), 0.69 (0.59-0.81), and 0.52 (0.46-0.58), respectively, while no difference in MI. These were consistent in 1:1 propensity-score matching analysis between SGLT-2i and DPP-4i users (n = 17 232 in each group).

CONCLUSIONS: In Japanese CVRD-free T2D patients, SGLT-2i initiation was associated with lower risk of cardiorenal diseases, stroke, and all-cause mortality compared to oGLD, suggesting preventive effect of SGLT-2i treatment in the early stage of T2D patients without CVRD manifestation.

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Lower heart failure and chronic kidney disease risks associated with sodium‐glucose cotransporter‐2 inhibitor use in Japanese type 2 diabetes patients without established cardiovascular and renal diseases

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