NEW research has revealed that sodium-glucose cotransporter 2 inhibitors (SGLT2is) are associated with an 18% reduction in total cardiovascular disease (CVD) risk compared with dipeptidyl peptidase 4 inhibitors (DPP4is) in patients with type 2 diabetes (T2D). This effect was particularly notable in patients at high risk of CVD recurrence, for whom SGLT2is reduced the CVD risk by up to 30%. These findings underscore the potential benefits of SGLT2i therapy in clinical practice, especially for T2D patients with pre-existing cardiovascular concerns.
The study was conducted using electronic medical records from the National Cheng Kung University Hospital in Taiwan, covering 2015 to 2021. Adults with T2D who had begun treatment with either SGLT2is or DPP4is between 2016 and 2019, and had up to six years of follow-up, were included in the analysis. Propensity score matching created 1632 comparable pairs, balancing demographic and clinical characteristics between the two groups. Statistical methods, including a shared frailty model, were employed to evaluate the association between these medications and total CVD outcomes, with adjustments for repeated CVD events and additional factors such as baseline renal function and history of diabetes-related complications. The study found that SGLT2is were associated with a hazard ratio of 0.82 (95% CI, 0.69-0.98) for total CVD risk compared to DPP4is, indicating a significant risk reduction. Among patients with an estimated glomerular filtration rate (eGFR) lower than 60 mL/min/1.73 m² or those with a history of CVD or other diabetes-related complications, the risk reduction with SGLT2is was more pronounced, with hazard ratios around 0.70 across these subgroups. Notably, women with a prior CVD history experienced the most substantial benefit from SGLT2i therapy, with a hazard ratio of 0.59 (95% CI, 0.49-0.72).
These findings suggest that SGLT2is should be favoured over DPP4is for patients with T2D, particularly for those at higher risk of CVD recurrence. The long-term benefits of SGLT2is in reducing recurrent CVD events support their prioritisation in clinical practice for high-risk patients. Further studies could explore the mechanisms underlying this gender-specific response and investigate optimal strategies for integrating SGLT2i therapy into diabetes and CVD management guidelines. This could help tailor treatment approaches to improve cardiovascular outcomes in patients with T2D, particularly among those with high-risk profiles.
Reference
Su H et al. Cardiovascular risks with sglt2 inhibitors in clinical practice among patients with type 2 diabetes. JAMA Netw Open. 2024;7(10):e2441765.
