Cardiovascular outcomes with SGLT2 inhibitors versus DPP4 inhibitors and GLP-1 receptor agonists in patients with heart failure with reduced and preserved ejection fraction

被引：19

作者：

Gonzalez, Jimmy ^{[1
,2
,3
]}

Bates, Benjamin A. ^{[3
,4
]}

Setoguchi, Soko ^{[3
,4
]}

Gerhard, Tobias ^{[1
,3
]}

Dave, Chintan V. ^{[1
,3
]}

机构：

[1] Rutgers State Univ, Ernest Mario Sch Pharm, Dept Pharm Pract & Adm, Piscataway, NJ 08854 USA

[2] Jersey Shore Univ Med Ctr, Dept Pharm, Neptune, NJ USA

[3] Rutgers State Univ, Inst Hlth, Ctr Pharmacoepidemiol & Treatment Sci, Hlth Care Policy & Aging Res, 112 Paterson St, New Brunswick, NJ 08901 USA

[4] Rutgers Robert Wood Johnson Med Sch, Dept Med, New Brunswick, NJ USA

来源：

CARDIOVASCULAR DIABETOLOGY | 2023年 / 22卷 / 01期

关键词：

Sodium-glucose cotransporter-2 inhibitors; Glucagon-like peptide-1 receptor agonists; Cardiovascular outcomes; Major adverse cardiovascular events; Heart failure; Stroke; Myocardial infarction; Hospitalization for heart failure; VALIDATED METHODS; PREVALENCE; MORTALITY; DISEASE; RISK;

D O I：

10.1186/s12933-023-01784-w

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BackgroundNo study has compared the cardiovascular outcomes for sodium-glucose cotransporter-2 inhibitors (SGLT2i) head-to-head against other glucose-lowering therapies, including dipeptidyl peptidase 4 inhibitor (DDP4i) or glucagon-like peptide-1 receptor agonist (GLP-1RA)-which also have cardiovascular benefits-in patients with heart failure with reduced (HFrEF) or preserved (HFpEF) ejection fraction.MethodsMedicare fee-for-service data (2013-2019) were used to create four pair-wise comparison cohorts of type 2 diabetes patients with: (1a) HFrEF initiating SGLT2i versus DPP4i; (1b) HFrEF initiating SGLT2i versus GLP-1RA; (2a) HFpEF initiating SGLT2i versus DPP4i; and (2b) HFpEF initiating SGLT2i versus GLP-1RA. The primary outcomes were (1) hospitalization for heart failure (HHF) and (2) myocardial infarction (MI) or stroke hospitalizations. Adjusted hazards ratios (HR) and 95% CIs were estimated using inverse probability of treatment weighting.ResultsAmong HFrEF patients, initiation of SGLT2i versus DPP4i (cohort 1a; n = 13,882) was associated with a lower risk of HHF (adjusted Hazard Ratio [HR (95% confidence interval)], 0.67 (0.63, 0.72) and MI or stroke (HR: 0.86 [0.75, 0.99]), and initiation of SGLT2i versus GLP-1RA (cohort 1b; n = 6951) was associated with lower risk of HHF (HR: 0.86 [0.79, 0.93]), but not MI or stroke (HR: 1.02 [0.85, 1.22]). Among HFpEF patients, initiation of SGLT2i versus DPP4i (cohort 2a; n = 17,493) was associated with lower risk of HHF (HR: 0.65 [0.61, 0.69]) but not MI or stroke (HR: 0.90 [0.79, 1.02]), and initiation of SGLT2i versus GLP-1RA (cohort 2b; n = 9053) was associated with lower risk of HHF (0.89 [0.83, 0.96]), but not MI or stroke (HR: 0.97 [0.83, 1.14]). Results were robust across range of secondary outcomes (e.g., all-cause mortality) and sensitivity analyses.ConclusionsBias from residual confounding cannot be ruled out. Use of SGLT2i was associated with reduced risk of HHF against DPP4i and GLP-1RA, reduced risk of MI or stroke against DPP4i within the HFrEF subgroup, and comparable risk of MI or stroke against GLP-1RA. Notably, the magnitude of cardiovascular benefit conferred by SGLT2i was similar among patients with HFrEF and HFpEF.

引用

页数：11