Dhana Rhuna, Aqel Yousef, Rawat Anurag, Mahato Aakash, Maali Abusal Abdelaziz, Munawar Nazish, Wei Calvin R, Amin Adil
Paediatrics, Alder Hey Children's Hospital, Liverpool, GBR.
Medicine, Hamad Medical Corporation, Doha, QAT.
Cureus. 2025 May 4;17(5):e83449. doi: 10.7759/cureus.83449. eCollection 2025 May.
Sodium-glucose co-transporter-2 (SGLT2) inhibitors have demonstrated significant cardiovascular benefits in patients with type 2 diabetes. However, head-to-head comparisons between dapagliflozin and empagliflozin, two widely prescribed SGLT2 inhibitors, remain limited. This meta-analysis aimed to directly compare the cardiovascular outcomes of these agents in patients with type 2 diabetes. We conducted a comprehensive literature search across multiple databases and included eight retrospective studies enrolling 280,617 patients (158,352 receiving empagliflozin and 122,265 receiving dapagliflozin). The primary outcome was major adverse cardiovascular events (MACE), with secondary outcomes including all-cause mortality, myocardial infarction, and stroke. Our pooled analysis revealed no significant difference in MACE risk between empagliflozin and dapagliflozin (RR: 1.04; 95% CI: 0.96 to 1.13). Similarly, no significant differences were observed for all-cause mortality (RR: 1.05; 95% CI: 0.96 to 1.15), myocardial infarction (RR: 1.04; 95% CI: 0.94 to 1.16), or stroke (RR: 1.00; 95% CI: 0.91 to 1.09). Subgroup analyses by gender, atherosclerotic cardiovascular disease, and chronic kidney disease status showed consistent results. However, in patients with heart failure, a trend toward reduced MACE risk was observed with empagliflozin (RR: 0.90; 95% CI: 0.82 to 1.00). Despite pharmacokinetic differences between these agents, our findings suggest comparable cardiovascular outcomes in patients with type 2 diabetes, with potentially enhanced benefits of empagliflozin in those with heart failure. However, due to lack of studies, this finding should be interpreted with caution. These results provide valuable insights for clinical decision-making when selecting SGLT2 inhibitors for cardiovascular risk reduction in diabetic patients. Further prospective studies are warranted to confirm these findings and explore potential mechanistic differences between these agents.
钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂已在2型糖尿病患者中显示出显著的心血管益处。然而，两种广泛应用的SGLT2抑制剂——达格列净和恩格列净之间的直接对比研究仍然有限。这项荟萃分析旨在直接比较这两种药物在2型糖尿病患者中的心血管结局。我们对多个数据库进行了全面的文献检索，纳入了8项回顾性研究，共280617例患者（158352例接受恩格列净治疗，122265例接受达格列净治疗）。主要结局是主要不良心血管事件（MACE），次要结局包括全因死亡率、心肌梗死和中风。我们的汇总分析显示，恩格列净和达格列净在MACE风险方面无显著差异（风险比：1.04；95%置信区间：0.96至1.13）。同样，在全因死亡率（风险比：1.05；95%置信区间：0.96至1.15）、心肌梗死（风险比：1.04；95%置信区间：0.94至1.16）或中风（风险比：1.00；95%置信区间：0.91至1.09）方面也未观察到显著差异。按性别、动脉粥样硬化性心血管疾病和慢性肾脏病状态进行的亚组分析显示结果一致。然而，在心力衰竭患者中，观察到恩格列净有降低MACE风险的趋势（风险比：0.90；95%置信区间：0.82至1.00）。尽管这两种药物在药代动力学上存在差异，但我们的研究结果表明，在2型糖尿病患者中，它们的心血管结局相当，恩格列净在心力衰竭患者中可能具有更大的益处。然而，由于缺乏研究，这一发现应谨慎解读。这些结果为临床决策提供了有价值的见解，有助于在为糖尿病患者选择SGLT2抑制剂以降低心血管风险时做出决策。有必要进行进一步的前瞻性研究以证实这些发现，并探索这些药物之间潜在的机制差异。
