Department of Pharmacy, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.
School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, No. 1, University Road, Tainan, 701, Taiwan.
Cardiovasc Diabetol. 2021 Oct 23;20(1):213. doi: 10.1186/s12933-021-01406-3.
The treatment effects on hospitalization for heart failure (hHF) from sodium-glucose cotransporter 2 (SGLT2) inhibitors may vary among type 2 diabetes (T2D) patients depending on whether or not they have established atherosclerotic cardiovascular diseases (ASCVD). We aimed to examine differences in hHF outcomes after dapagliflozin or empagliflozin use between T2D patients with and without a history of established ASCVD.
We conducted a retrospective multi-institutional cohort study in Taiwan. We included T2D patients newly receiving dapagliflozin or empagliflozin during 2016-2019, and followed them up until December 31, 2020. We implemented 1:1 propensity score matching to create homogenous groups for comparisons. We generated Cox proportional hazard models to compare the risk of hHF between dapagliflozin and empagliflozin (reference group). We included interaction terms of SGLT2 inhibitor and ASCVD history in the regression models to examine effect modification by ASCVD.
We included a total cohort of 9,586 dapagliflozin new users and 9,586 matched empagliflozin new users. The overall hHF risks were similar for dapagliflozin and empagliflozin (HR: 0.90, 95% CI 0.74-1.09). However, differential hHF risks between dapagliflozin and empagliflozin were observed only in the subgroup without ASCVD (HR: 0.67, 95% CI 0.49-0.90), while not in the subgroup with ASCVD (HR: 1.12, 95% 0.87-1.45), and the p-value for examining interaction was 0.0097.
In this study, history of established ASCVD was associated with different hHF risks among SGLT2 inhibitors. For T2D patients without ASCVD, dapagliflozin may offer a more favorable hHF reduction effect, compared to empagliflozin, in clinical practice. Future prospective studies should be conducted to validate our findings.
钠-葡萄糖共转运蛋白 2（SGLT2）抑制剂对心力衰竭（HF）住院的治疗效果可能因 2 型糖尿病（T2D）患者是否存在已确立的动脉粥样硬化性心血管疾病（ASCVD）而有所不同。我们旨在研究在有或没有 ASCVD 病史的 T2D 患者中，使用达格列净或恩格列净后 HF 结局的差异。
我们在台湾进行了一项回顾性多机构队列研究。我们纳入了 2016 年至 2019 年期间新接受达格列净或恩格列净治疗的 T2D 患者，并随访至 2020 年 12 月 31 日。我们采用 1:1 倾向评分匹配创建同质组进行比较。我们生成 Cox 比例风险模型比较达格列净和恩格列净（参照组）之间 HF 的风险。我们在回归模型中纳入 SGLT2 抑制剂和 ASCVD 病史的交互项，以检验 ASCVD 的修饰作用。
我们纳入了一个共 9586 例达格列净新使用者和 9586 例匹配的恩格列净新使用者的总队列。达格列净和恩格列净的总体 HF 风险相似（HR：0.90，95%CI 0.74-1.09）。然而，仅在无 ASCVD 亚组中观察到达格列净和恩格列净之间的 HF 风险存在差异（HR：0.67，95%CI 0.49-0.90），而在 ASCVD 亚组中则无差异（HR：1.12，95%CI 0.87-1.45），检验交互作用的 p 值为 0.0097。
在这项研究中，已确立的 ASCVD 史与 SGLT2 抑制剂之间的不同 HF 风险相关。对于无 ASCVD 的 T2D 患者，与恩格列净相比，达格列净在临床实践中可能提供更有利的 HF 降低效果。未来应进行前瞻性研究以验证我们的发现。
