Why is this important?
- Whether patients with T2D who have risk factors for CVAS but no established CVD would benefit from SGLT2i is unclear.
Methodology
- The study included 1,685 patients who received a first prescription for an SGLT2i within 12 months, matched according to propensity scores to 1,685 patients who received a first prescription following 12 months, divided into 3 groups: known MCVAS, risk factors cardiovascular (CV), and no MCVAS or risk factors.
- Primary endpoint: three-component major adverse cardiovascular events (MCAEs) defined as nonfatal cerebrovascular accident (CVA), nonfatal myocardial infarction (MI), and CV death.
- Funding: no funding was disclosed.
Principle results
- During a median follow-up of 2.8 years, the hazard ratio (RR) of MCEI for initiation of SGLT2i at 12 months, compared to initiation at 12 months, was 0.27 ( confidence interval [IC] at 95%: 0.17–0.42).
- Similar results were seen in subgroup analyzes of patients with CVD risk factors or known CVD, but not in those without risk factors or CVD (Pinteraction = 0,001).
- The initiation of SGLT2i was associated with a reduction in MI and CV death, but not ischemic stroke.
- MCVAS and/or risk factors alone and delayed use of SGLT2i contributed to additional ACE rates of 5.87 and 0.13 cases per 1000 person-years, respectively.
Limits
- “Early” initiation was set arbitrarily at 12 months.
- No assessment of persistence of SGLT2i use.
- Potential residual confounders.
- Propensity score matching led to a reduction in sample size.