Cardiovascular outcomes with sodium–glucose cotransporter-2 inhibitors vs other glucose-lowering drugs in 13 countries across three continents: analysis of CVD-REAL data

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dc.contributor.authorKhunti, Kamlesh
dc.contributor.authorKosiborod, Mikhail
dc.contributor.authorKim, Dae J.
dc.contributor.authorKohsaka, Shun
dc.contributor.authorLam, Carolyn S. P.
dc.contributor.authorGoh, Su-Yen
dc.contributor.authorChiang, Chern-En
dc.contributor.authorShaw, Jonathan E.
dc.contributor.authorCavender, Matthew A.
dc.contributor.authorTangri, Navdeep
dc.contributor.authorFranch-Nadal, Josep
dc.contributor.authorHoll, Reinhard W.
dc.contributor.authorJørgensen, Marit E.
dc.contributor.authorNorhammar, Anna
dc.contributor.authorEriksson, Johan G.
dc.contributor.authorZaccardi, Francesco
dc.contributor.authorKarasik, Avraham
dc.contributor.authorMagliano, Dianna J.
dc.contributor.authorThuresson, Marcus
dc.contributor.authorChen, Hungta
dc.contributor.authorWittbrodt, Eric
dc.contributor.authorBodegård, Johan
dc.contributor.authorSurmont, Filip
dc.contributor.authorFenici, Peter
dc.date.accessioned2021-08-01T03:17:38Z
dc.date.issued2021-07-31
dc.date.updated2021-08-01T03:17:38Z
dc.description.abstractAbstract 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 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. 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
dc.identifier.citationCardiovascular Diabetology. 2021 Jul 31;20(1):159
dc.identifier.urihttps://doi.org/10.1186/s12933-021-01345-z
dc.identifier.urihttp://hdl.handle.net/1993/35768
dc.language.rfc3066en
dc.rightsopen accessen_US
dc.rights.holderThe Author(s)
dc.titleCardiovascular outcomes with sodium–glucose cotransporter-2 inhibitors vs other glucose-lowering drugs in 13 countries across three continents: analysis of CVD-REAL data
dc.typeJournal Article
local.author.affiliationRady Faculty of Health Sciencesen_US
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