Comparative Cardiovascular Outcomes of Dapagliflozin Versus Empagliflozin in Patients With Type 2 Diabetes: A Meta-Analysis.

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.