Khunti, Kamlesh, Kosiborod, Mikhail, Kim, Dae Jung, Kohsaka, Shun, Lam, Carolyn SP, Goh, Su-Yen, Chiang, Chern-En, Shaw, Jonathan E, Cavender, Matthew A, Tangri, Navdeep et al (show 14 more authors)
(2021)
Cardiovascular outcomes with sodium-glucose cotransporter-2 inhibitors vs other glucose-lowering drugs in 13 countries across three continents: analysis of CVD-REAL data.
CARDIOVASCULAR DIABETOLOGY, 20 (1).
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Cardiovascular outcomes with sodium-glucose cotransporter-2 inhibitors vs other glucose-lowering drugs in 13 countries acros.pdf - Published version Download (2MB) | Preview |
Abstract
<h4>Background</h4>Randomized, controlled cardiovascular outcome trials may not be fully representative of the management of patients with type 2 diabetes across different geographic regions. We conducted analyses of data from the multinational CVD-REAL consortium to determine the association between initiation of sodium-glucose cotransporter-2 inhibitors (SGLT-2i) and cardiovascular outcomes, including subgroup analyses based on patient characteristics.<h4>Methods</h4>De-identified health records from 13 countries across three continents were used to identify patients newly-initiated on SGLT-2i or other glucose-lowering drugs (oGLDs). Propensity scores for SGLT-2i initiation were developed in each country, with 1:1 matching for oGLD initiation. In the matched groups hazard ratios (HRs) for hospitalization for heart failure (HHF), all-cause death (ACD), the composite of HHF or ACD, myocardial infarction (MI) and stroke were estimated by country, and pooled using a weighted meta-analysis. Multiple subgroup analyses were conducted across patient demographic and clinical characteristics to examine any heterogeneity in treatment effects.<h4>Results</h4>Following matching, 440,599 new users of SGLT-2i and oGLDs were included in each group. Mean follow-up time was 396 days for SGLT-2i initiation and 406 days for oGLDs initiation. SGLT-2i initiation was associated with a lower risk of HHF (HR: 0.66, 95%CI 0.58-0.75; p < 0.001), ACD (HR: 0.52, 95%CI 0.45-0.60; p < 0.001), the composite of HHF or ACD (HR: 0.60, 95%CI 0.53-0.68; p < 0.001), MI (HR: 0.85, 95%CI 0.78-0.92; p < 0.001), and stroke (HR: 0.78, 95%CI 0.72-0.85; p < 0.001); regardless of patient characteristics, including established cardiovascular disease, or geographic region.<h4>Conclusions</h4>This CVD-REAL study extends the findings from the SGLT-2i clinical trials to the broader setting of an ethnically and geographically diverse population, and across multiple subgroups. Trial registration NCT02993614.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | Sodium-glucose cotransporter-2 inhibitors, Cardiovascular outcomes, Heart failure, Type 2 diabetes |
| Divisions: | Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 09 Dec 2021 12:32 |
| Last Modified: | 18 Jan 2023 21:23 |
| DOI: | 10.1186/s12933-021-01345-z |
| Related URLs: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3145078 |
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