Circulation

Estimated Lifetime Heart, Kidney, and Survival Benefits of Combining Three Drugs Compared to Usual Care in Type 2 Diabetes Patients with Protein in Their Urine

Updated

Abstract

The combination of SGLT2 inhibitors, GLP-1 receptor agonists, and the mineralocorticoid receptor antagonist finerenone is associated with a hazard ratio of 0.65 for major adverse cardiovascular events compared to conventional care.

  • Estimated absolute risk reduction for major adverse cardiovascular events over 3 years is 4.4%.
  • For a 50-year-old patient, estimated major adverse cardiovascular event-free survival is 21.1 years with combination therapy versus 17.9 years with conventional care.
  • Projected gains in survival free from hospitalized heart failure are 3.2 years.
  • Chronic kidney disease progression may be delayed by an estimated 5.5 years with combination therapy.
  • There are potential improvements in survival from cardiovascular death and all-cause death of 2.2 years and 2.4 years, respectively.

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Funding

Competing interests

Disclosures Dr Neuen has received fees for travel support, advisory boards, scientific presentations, and steering committee roles from AstraZeneca, Alexion, Bayer, Boehringer and Ingelheim, Cambridge Healthcare Research, Cornerstone Medical Education, Janssen, the limbic, and Medscape, with all honoraria paid to The George Institute for Global Health. Dr Heerspink is a consultant for AstraZeneca, Bayer, Boehringer Ingelheim, Chinook, CSL Behring, Dimerix, Eli-Lilly, Gilead, Janssen, Merck, Novo Nordisk, ProKidney, Travere Therapeutics, and Vifor Fresenius. He has received research support from AstraZeneca, Boehringer Ingelheim, Janssen, and Novo Nordisk. Dr Claggett has received consulting fees from Alnylam, Cardurion, Corvia, Cytokinetics, and Intellia, Rocket. Dr Arnott has received honoraria from AstraZeneca, Novo Nordisk, and Amgen. Dr Pearson is a member of the Drug Utilisation Sub-Committee of the Australian Pharmaceutical Benefits Advisory Committee. The views expressed in this article do not represent those of the committee. Dr Mahaffey has received research support from Afferent, Amgen, Apple Inc, AstraZeneca, Cardiva Medical Inc, Daiichi, Ferring, Google (Verily), Johnson & Johnson, Luitpold, Medtronic, Merck, National Institutes of Health, Novartis, Sanofi, St. Jude, and Tenax, and has served as a consultant (speaker fees for continuing medical education events only) for Abbott, Ablynx, AstraZeneca, Baim Institute, Boehringer Ingelheim, Bristol-Myers Squibb, Elsevier, GlaxoSmithKline, Johnson & Johnson, MedErgy, Medscape, Mitsubishi Tanabe, Myokardia, NIH, Novartis, Novo Nordisk, Portola, Radiometer, Regeneron, Springer Publishing, and University of California, San Francisco. Dr Neal has held research grants for large-scale cardiovascular outcome trials of sodium glucose co-transporter 2 from Janssen, and his institution has received consultancy, honoraria, and travel support for contributions he has made to advisory boards or the continuing medical education programs of Janssen. Dr Agarwal has received consultancy fees from Vifor, Boehringer Ingelheim, Eli Lilly, Akebia, Reata, Diamedica, Bayer, Chinook, and Vertex. Dr Bakris reports research funding, paid to the University of Chicago Medicine, from Bayer, Novo Nordisk, and Vascular Dynamics; has acted as a consultant and received personal fees from for Alnylam, Merck, and Relypsa; is an editor of the American Journal of Nephrology, Nephrology and Hypertension , and section editor of UpToDate ; and is an associate editor of Diabetes Care and Hypertension Research . Dr Perkovic serves as a board director for St. Vincent’s Health Australia, George Clinical, and several medical research institutes. He has received honoraria for steering committee roles, scientific presentations, and advisory board attendance from Abbvie, Amgen, Astra Zeneca, Bayer, Baxter, Boehringer Ingelheim, Chinook, Durect, Eli Lilly, Gilead, GSK, Janssen, Merck, Mitsubishi Tanabe, Mundipharma, Novartis, Novo Nordisk, Otsuka, Pharmalink, Pfizer, Reata, Travere, Relypsa, Roche, Sanofi, Servier, and Tricida. Dr Solomon has received research grants (paid to institution) from Actelion, Alnylam, Amgen, AstraZeneca, Bellerophon, Bayer, Bristol Myers Squibb, Celladon, Cytokinetics, Eidos, Gilead, GlaxoSmithKline, Ionis, Eli Lilly, Mesoblast, MyoKardia, National Institutes of Health/National Heart, Lung, and Blood Institute, Neurotronik, Novartis, NovoNordisk, Respicardia, Sanofi Pasteur, Theracos, US2.AI; and has consulted for Abbott, Action, Akros, Alnylam, Amgen, Arena, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Cardior, Cardurion, Corvia, Cytokinetics, Daiichi-Sankyo, GlaxoSmithKline, Eli Lilly, Merck, Myokardia, Novartis, Roche, Theracos, Quantum Genomics, Cardurion, Janssen, Cardiac Dimensions, Tenaya, Sanofi-Pasteur, Dinaqor, Tremeau, CellProThera, Moderna, American Regent, Sarepta, Lexicon, Anacardio, and Valo. Dr Vaduganathan has received research grant support, served on advisory boards, or had speaker engagements with American Regent, Amgen, AstraZeneca, Bayer AG, Baxter Healthcare, Boehringer Ingelheim, Chiesi, Cytokinetics, Lexicon Pharmaceuticals, Merck, Novartis, Novo Nordisk, Pharmacosmos, Relypsa, Roche Diagnostics, Sanofi, and Tricog Health, and participates on clinical trial committees for studies sponsored by AstraZeneca, Galmed, Novartis, Bayer AG, Occlutech, and Impulse Dynamics. All other authors report no relevant disclosures.
PubMed

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