JAMA cardiology

SGLT2 Inhibitors and Their Links to Heart and Kidney Health in Type 2 Diabetes: A Combined Analysis

Updated

Abstract

Data from 6 trials comprised 46,969 unique patients with type 2 diabetes.

  • SGLT2 inhibitors are associated with a reduced risk of major adverse cardiovascular events (HR, 0.90).
  • There is a significant reduction in the risk of hospitalization for heart failure or cardiovascular death (HR, 0.78).
  • SGLT2 inhibitors are associated with improved kidney outcomes (HR, 0.62).
  • The reduction in hospitalization for heart failure is consistently observed across trials (HR, 0.68).
  • Significant heterogeneity in associations with cardiovascular death was noted among the trials (HR, 0.85).
  • The presence of atherosclerotic cardiovascular disease does not modify the association with major adverse cardiovascular events.

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Funding

Competing interests

Conflict of Interest Disclosures: Dr McGuire reported receiving honoraria for clinical trial leadership from AstraZeneca, Boehringer Ingelheim, Eisai, Esperion, GlaxoSmithKline, Janssen, Lexicon, Merck, Novo Nordisk, and Sanofi, and consultancy fees from Afimmune, Applied Therapeutics, AstraZeneca, Boehringer Ingelheim, Lilly, Merck, Pfizer, Novo Nordisk, Metavant, and Sanofi outside the submitted work. Dr McGuire reported receiving personal fees and nonfinancial support from Merck and nonfinancial support from Pfizer outside the submitted work. Dr Cannon reported receiving grants and personal fees from Merck and Pfizer during the conduct of the study; grants from Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Daiichi Sankyo, Janssen, Merck, and Pfizer; and personal fees from Aegerion, Alnylam, Amarin, Amgen, Applied Therapeutics, Ascendia, Boehringer Ingelheim, Bristol Myers Squibb, Corvidia, Eli Lilly, HLS Therapeutics, Innovent, Janssen, Kowa, Merck, Pfizer, Rhoshan, and Sanofi outside the submitted work. Dr Cosentino reported receiving fees from Abbott, AstraZeneca, Bayer, Bristol Myers Squibb, Merck Sharp & Dohme, Novo Nordisk, and Pfizer; research grants from Swedish Research Council, Swedish Heart & Lung Foundation, and the King Gustav V and Queen Victoria Foundation; nonfinancial support from Merck Sharp & Dohme and Pfizer; and personal fees from Abbott, AstraZeneca, Bayer, Bristol Myers Squibb, Merck Sharp & Dohme, Novo Nordisk, and Pfizer outside the submitted work. Dr Charbonnel reported receiving personal fees from Merck, Pfizer, AstraZeneca, Sanofi, Novo Nordisk, MundiPharma, and Lilly and fees from AstraZeneca, Boehringer Ingelheim, Lilly, Merck Sharp & Dohme, Novo Nordisk, Sanofi, and Takeda during the conduct of the study. Dr Cherney reported receiving personal fees from Boehringer Ingelheim-Eli Lilly, Merck, AstraZeneca, Sanofi, Mitsubishi-Tanabe, AbbVie, Janssen, Bayer, Prometic, Bristol Myers Squibb, and Novo Nordisk; and operating grants from Boehringer Ingelheim-Eli Lilly, Merck, Janssen, Sanofi, AstraZeneca, and Novo Nordisk outside the submitted work. Dr Dagogo-Jack reported leading clinical trials for AstraZeneca, Boehringer Ingelheim, and Novo Nordisk; consulting fees from AstraZeneca, Boehringer Ingelheim, Janssen, Merck, and Sanofi; and equity interests in Jana Care Inc and Aerami outside the submitted work. Dr Pratley reported receiving research grants, consulting, or speaker fees (directed to AdventHealth) from Hanmi Pharmaceutical Co Ltd, Janssen, Merck, Novo Nordisk, Pfizer, Poxel SA, Sanofi, Scohia Pharma, and Sun Pharmaceutical Industries; publication support from Merck; speaker and consulting fees from AstraZeneca; consulting fees from GlaxoSmithKline, Glytec, and Janssen; grants from Lexicon Pharmaceuticals; and grants and consulting fees from Ligand Pharmaceuticals, Lilly, Sanofi, and Merck outside the submitted work. All payments for Dr Pratley's services were made directly to AdventHealth, a nonprofit organization. Dr Shih reported serving as consultant to the scientific advisory committee of Merck. Drs Gantz and Huyck reported being employees of Merck & Co, Inc, Kenilworth, New Jersey, and own stock in the company. Ms Greenberg and Drs Wang, Terra, and Masiukiewicz reported being employees and shareholders of Pfizer. No other disclosures were reported.
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