Steno Diabetes Center Copenhagen, Copenhagen, Denmark.
Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
Cardiovasc Diabetol. 2023 Aug 31;22(1):233. doi: 10.1186/s12933-023-01963-9.
Studies that have reported lower risk for cardiovascular outcomes in users of Sodium-Glucose Cotransporter-2 Inhibitors (SGLT-2i) are limited by residual cofounding and lack of information on prior cardiovascular disease (CVD). This study compared risk of cardiovascular events in patients within routine care settings in Europe and Asia with type 2 diabetes (T2D) initiating empagliflozin compared to dipeptidyl peptidase-4 inhibitors (DPP-4i) stratified by pre-existing CVD and history of heart failure (HF).
Adults initiating empagliflozin and DPP-4i in 2014-2018/19 from 11 countries in Europe and Asia were compared using propensity score matching and Cox proportional hazards regression to assess differences in rates of primary outcomes: hospitalisation for heart failure (HHF), myocardial infarction (MI), stroke; and secondary outcomes: cardiovascular mortality (CVM), coronary revascularisation procedure, composite outcome including HHF or CVM, and 3-point major adverse cardiovascular events (MACE: MI, stroke and CVM). Country-specific results were meta-analysed and pooled hazard ratios (HR) with 95% confidence intervals (CI) from random-effects models are presented. In total, 85,244 empagliflozin/DPP4i PS-matched patient pairs were included with overall mean follow-up of 0.7 years. Among those with pre-existing CVD, lower risk was observed for HHF (HR 0.74; 95% CI 0.64-0.86), CVM (HR 0.55; 95% CI 0.38-0.80), HHF or CVM (HR 0.57; 95% CI 0.48-0.67) and stroke (HR 0.79; 95% CI 0.67-0.94) in patients initiating empagliflozin vs DPP-4i. Similar patterns were observed among patients without pre-existing CVD and those with and without pre-existing HF.
These results from diverse patient populations in routine care settings across Europe and Asia demonstrate that initiation of empagliflozin compared to DPP-4i results in favourable cardioprotective effects regardless of pre-existing CVD or HF status.
已有研究报告称，钠-葡萄糖共转运蛋白 2 抑制剂（SGLT-2i）的使用者发生心血管结局的风险较低，但这些研究受到残余混杂因素的限制，且缺乏关于先前心血管疾病（CVD）的信息。本研究比较了在欧洲和亚洲常规医疗环境中接受恩格列净或二肽基肽酶-4 抑制剂（DPP-4i）治疗的 2 型糖尿病（T2D）患者的心血管事件风险，这些患者按预先存在的 CVD 和心力衰竭（HF）病史进行分层。
2014 年至 2018/19 年期间，来自欧洲和亚洲 11 个国家的成年人开始使用恩格列净或 DPP-4i，通过倾向评分匹配和 Cox 比例风险回归来比较主要结局（因心力衰竭住院[HHF]、心肌梗死[MI]、中风）和次要结局（心血管死亡率[CVM]、冠状动脉血运重建术、包括 HHF 或 CVM 的复合结局以及 3 点主要不良心血管事件[MACE：MI、中风和 CVM]）的发生率差异。对各国的结果进行了荟萃分析，并呈现了来自随机效应模型的 95%置信区间（CI）的合并危险比（HR）。共纳入 85244 对恩格列净/DPP4i 倾向评分匹配患者，总体平均随访 0.7 年。在那些有预先存在的 CVD 的患者中，与 DPP-4i 相比，恩格列净降低了 HHF（HR 0.74；95%CI 0.64-0.86）、CVM（HR 0.55；95%CI 0.38-0.80）、HHF 或 CVM（HR 0.57；95%CI 0.48-0.67）和中风（HR 0.79；95%CI 0.67-0.94）的风险。在没有预先存在的 CVD 的患者以及有和没有预先存在的 HF 的患者中，观察到了类似的模式。
这些来自欧洲和亚洲常规医疗环境中不同患者人群的结果表明，与 DPP-4i 相比，恩格列净的起始治疗可带来有利的心脏保护作用，无论预先存在的 CVD 或 HF 状况如何。
