Department of Medical Sciences, Ajou University Graduate School, Suwon, Republic of Korea.
Department of Internal Medicine, Incheon Medical Center, Incheon, Republic of Korea.
Cardiovasc Diabetol. 2018 Jun 23;17(1):91. doi: 10.1186/s12933-018-0737-5.
Recently, two large randomized controlled trials which only included patients with underlying cardiovascular disease (CVD) or patients at high risk for CVD showed that two sodium glucose co-transporter 2 inhibitors (SGLT-2is) significantly reduced hospitalization for heart failure (hHF), with an early separation in the survival curves for hHF. There were concerns whether SGLT-2i use could protect hHF in patients without CVD and how soon SGLT-2i-treated patients show a lower risk of hHF. Thus, we aimed to evaluate whether the heart failure protective effect of SGLT-2i differs depending on the underlying CVD and the prescription period compared with dipeptidyl peptidase-4 inhibitors (DPP-4i).
We performed a nationwide retrospective observational study to estimate the effect of SGLT-2i on HF. The 59,479 SGLT-2i new-users were matched with same number of DPP-4i new-users through propensity score matching using 53 confounding variables. Kaplan-Meier (K-M) curves and Cox proportional hazards regression analyses were used to estimate the risk of hospitalization for hHF.
The incidence rates of hHF were 0.83 and 1.13 per 100 person-years in SGLT-2i-treated patients and DPP-4i-treated patients, respectively. The hazard ratios of hHF were 0.66 (95% confidence interval 0.58-0.75) in SGLT-2i-treated patients compared with the DPP-4i-treated patients. Among the patients with underlying CVD, SGLT-2i-treated patients were associated with a lower risk of hHF from 30 days to 3 years after initiating drugs compared with DPP-4i. However, SGLT-2i use only showed a lower risk of hHF with a significant difference 3 years after drug initiation among patients without underlying CVD.
Our findings suggest that SGLT-2i reduced hHF compared with DPP-4i. A heart failure protective effect of SGLT-2i use vs. DPP-4i use was shown 30 days after initiating the SGLT-2i among patients with established CVD, but this effect appeared later in patients without established CVD.
最近，两项仅纳入存在心血管疾病（CVD）或 CVD 高危患者的大型随机对照试验表明，两种钠-葡萄糖共转运蛋白 2 抑制剂（SGLT-2i）可显著降低心力衰竭（HF）住院率，HF 患者的生存曲线出现早期分离。人们担心 SGLT-2i 是否能保护无 CVD 的 HF 患者，以及 SGLT-2i 治疗患者多久后 HF 风险降低。因此，我们旨在评估 SGLT-2i 是否与二肽基肽酶-4 抑制剂（DPP-4i）相比，根据潜在 CVD 和处方时间的不同，对 HF 有不同的保护作用。
我们进行了一项全国性回顾性观察性研究，以评估 SGLT-2i 对 HF 的影响。通过使用 53 个混杂变量进行倾向评分匹配，将 59479 名 SGLT-2i 新使用者与相同数量的 DPP-4i 新使用者相匹配。使用 Kaplan-Meier（K-M）曲线和 Cox 比例风险回归分析来估计 HF 住院风险。
SGLT-2i 治疗患者的 HF 发生率为每 100 人年 0.83 例，DPP-4i 治疗患者为 1.13 例。与 DPP-4i 治疗患者相比，SGLT-2i 治疗患者的 HF 风险比为 0.66（95%置信区间 0.58-0.75）。在存在 CVD 的患者中，与 DPP-4i 相比，SGLT-2i 治疗患者在开始药物治疗后 30 天至 3 年内 HF 风险较低。然而，在无 CVD 的患者中，SGLT-2i 治疗仅在药物开始后 3 年显示出 HF 风险显著降低。
我们的研究结果表明，与 DPP-4i 相比，SGLT-2i 降低了 HF。在患有既定 CVD 的患者中，开始使用 SGLT-2i 后 30 天，SGLT-2i 与 DPP-4i 相比显示出 HF 保护作用，但在无既定 CVD 的患者中，这种作用出现较晚。
