bims-hafaim 2024-03-10 papers

Issue of 2024–03–10
two papers selected by
Kyle McCommis, Saint Louis University

Am J Cardiol. 2024 Mar 01. pii: S0002-9149(24)00161-9. [Epub ahead of print]

Cardiovascular Outcomes With Empagliflozin and Dapagliflozin in Patients Without Diabetes.

Sahib Singh, Aakash Garg, Udaya S Tantry, Kevin Bliden, Paul A Gurbel, Martha Gulati.

While the cardiovascular (CV) benefits with sodium-glucose cotransporter-2 inhibitors (SGLT2i) in patients with diabetes mellitus (DM) are well known, their effects in patients without DM continue to be explored. We provide a meta-analysis of the available evidence. Online databases were searched for randomized controlled trials (RCTs) comparing SGLT2i to placebo/control in patients without DM. The endpoints of interest were composite CV death/hospitalization for heart failure (HF) with individual components, all cause death, major adverse CV events (MACE) and serious adverse events. Subgroup analysis was performed according to the type of SGLT2i. Pooled odds ratios (OR) and 95% confidence intervals (CI) were generated via a random-effects model. A total of 6 RCTs with 12,984 patients (6,501 in the SGLT2i group and 6,483 in the placebo group) were included, followed over a mean duration of 17.7 months. Four RCTs had patients with HF, 1 with chronic kidney disease (CKD) and 1 with myocardial infarction (MI). The mean age was 64 years, 72% patients were men and mean HbA1C was 5.7%. As compared to placebo, SGLT2i treatment was associated with significant reduction in composite CV death or hospitalization for HF (OR 0.77, 95% CI 0.68 - 0.87, p < 0.0001), primarily due to decrease in hospitalization for HF (OR 0.70, 95% CI 0.60 - 0.81, p < 0.00001). No significant differences were found pertaining to CV death (OR 0.86, 95% CI 0.74 - 1.01, p = 0.06), all cause death (OR 0.89, 95% CI 0.71 - 1.11, p = 0.29) and MACE (OR 0.95, 95% CI 0.68 - 1.32, p = 0.75). Serious adverse events were lower with use of empagliflozin vs placebo. In conclusion, this study shows significant CV benefits in terms of reduction in CV death or hospitalization for HF in non-diabetic patients treated with SGLT2i as compared to placebo. The underlying heterogeneity of patients in terms of comorbidities (HF, CKD or MI) needs to be considered while interpreting the results.

Keywords: Sodium-glucose cotransporter-2 inhibitors; cardiovascular events; patients without diabetes

DOI: https://doi.org/10.1016/j.amjcard.2024.02.039

Clin Cardiol. 2024 Feb;47(3): e24248

Cardiovascular outcomes between dapagliflozin versus empagliflozin in patients with diabetes mellitus.

Jee-Heon Kim, Young-Chae Yoon, Young-Hoon Kim, Jong-Il Park, Kang-Un Choi, Jong-Ho Nam, Chan-Hee Lee, Jang-Won Son, Jong-Seon Park, Ung Kim.

BACKGROUND: Sodium-glucose co-transporter 2 (SGLT2) inhibitors have been demonstrated to decrease cardiovascular adverse events. However, there is little real-world clinical evidence regarding a direct comparison between dapagliflozin and empagliflozin in patients with diabetes mellitus (DM).
HYPOTHESIS: A difference in the cardiovascular efficancy of dapagliflozin versus empagliflozin in DM patients was anticipated, aiming to guide the optimal choice of SGLT2 inhibitors based on cardiovascular outcomes.
METHODS: From 2014 to 2020, a total of 1549 patients with DM who were prescribed SGLT2 inhibitors such as dapagliflozin or empagliflozin were retrospectively enrolled. We categorized the study population into two groups: dapagliflozin (n = 981) and empagliflozin group (n = 568). The primary endpoint was major adverse cardiovascular events (MACE), defined as a composite of all-cause death, myocardial infarction (MI), stroke, or hospitalization for heart failure (HF) over a 3-year period.
RESULTS: Propensity-score matching was performed (537 patients in each group). The mean age and hemoglobin A1c were 58.2 ± 13.0 years and 8.4 ± 1.7%, respectively. There was no significant difference between the dapagliflozin and empagliflozin groups in the risk of MACE (3.7% vs. 4.8%, hazard ratio [HR], 1.31; 95% confidence interval [CI], 0.73-2.35; p = 0.349). Furthermore, there were no differences between the two groups in secondary endpoints including all-cause death, MI, stroke, and hospitalization for HF. Prior MI and history of HF were independent predictors of MACE.
CONCLUSIONS: Dapagliflozin and empagliflozin showed no significant difference of real-world clinical cardiovascular outcomes in patients with DM over a 3-year period. Further large randomized clinical trials will be warranted for better evaluation.

Keywords: dapagliflozin; diabetes mellitus; empagliflozin; major adverse cardiovascular events

DOI: https://doi.org/10.1002/clc.24248