Cardiovascular outcomes with sodium-glucose cotransporter-2 inhibitors vs other glucose-lowering drugs in 13 countries across three continents: analysis of CVD-REAL data.
Cardiovasc Diabetol
; 20(1): 159, 2021 07 31.
Article
em En
| MEDLINE
| ID: mdl-34332558
ABSTRACT
BACKGROUND:
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.METHODS:
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 11 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.RESULTS:
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.CONCLUSIONS:
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.Palavras-chave
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Base de dados:
MEDLINE
Assunto principal:
Glicemia
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Doenças Cardiovasculares
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Diabetes Mellitus Tipo 2
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Inibidores do Transportador 2 de Sódio-Glicose
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Controle Glicêmico
Idioma:
En
Ano de publicação:
2021
Tipo de documento:
Article