Effect of Canagliflozin on Heart Failure Hospitalization in Diabetes According to Baseline Heart Failure Risk

被引：9

作者：

Khan, Muhammad Shahzeb ^{[1
]}

Segar, Matthew W. ^{[2
]}

Usman, Muhammad Shariq ^{[3
]}

V. Patel, Kershaw ^{[4
]}

Van Spall, Harriette G. C. ^{[5
]}

Devore, Adam D. ^{[1
,6
]}

Vaduganathan, Muthiah ^{[7
]}

Lam, Carolyn S. P. ^{[8
]}

Zannad, Faiez ^{[9
]}

Verma, Subodh ^{[10
]}

Butler, Javed ^{[3
,11
]}

Tang, W. H. Wilson ^{[12
]}

Pandey, Ambarish ^{[13
,14
]}

机构：

[1] Duke Univ, Sch Med, Div Cardiol, Durham, NC USA

[2] Texas Heart Inst, Dept Cardiol, Houston, TX USA

[3] Univ Mississippi, Med Ctr, Dept Med, Jackson, MS USA

[4] Houston Methodist DeBakey Heart & Vasc Ctr, Dept Cardiol, Houston, TX USA

[5] McMaster Univ, Populat Hlth Res Inst, Res Inst St Josephs, Dept Med, Hamilton, ON, Canada

[6] Duke Clin Res Inst, Durham, NC USA

[7] Harvard Med Sch, Brigham & Womens Hosp, Heart & Vasc Ctr, Dept Med, Boston, MA USA

[8] Duke Natl Univ Singapore, Natl Heart Ctr Singapore, Singapore, Singapore

[9] Univ Lorraine, CIC Insert, CHRU, Nancy, France

[10] Univ Toronto, St Michaels Hosp, Div Cardiac Surg, Toronto, ON, Canada

[11] Baylor Scott & White Res Inst, Dallas, TX USA

[12] Cleveland Clin, Dept Cardiovasc Med, Cleveland, OH USA

[13] Univ Texas Southwestern Med Ctr, Dept Internal Med, Div Cardiol, Dallas, TX USA

[14] Univ Texas Southwestern Med Ctr, Dept Internal Med, Div Cardiol, 5323 Harry Hines Blvd, Dallas, TX 75390 USA

来源：

JACC-HEART FAILURE | 2023年 / 11卷 / 07期

基金：

美国国家卫生研究院;

关键词：

diabetes; heart failure; risk scores; TRS-HFDM; WATCH-DM; CARDIOVASCULAR ASSESSMENT; PREDICTION; RATIONALE; DESIGN; ADULTS;

D O I：

10.1016/j.jchf.2023.03.025

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND In the CANVAS (Canagliflozin Cardiovascular Assessment Study) program, canagliflozin reduced the risk of heart failure (HF) hospitalization among individuals with type 2 diabetes mellitus (T2DM).OBJECTIVES The purpose of this study was to evaluate heterogeneity in absolute and relative treatment effects of canagliflozin on HF hospitalization according to baseline HF risk as assessed by diabetes-specific HF risk scores (WATCH-DM [Weight (body mass index), Age, hyperTension, Creatinine, HDL-C, Diabetes control (fasting plasma glucose) and QRS Duration, MI and CABG] and TRS-HFDM [TIMI Risk Score for HF in Diabetes]).METHODS Participants in the CANVAS trial were categorized into low, medium, and high risk for HF using the WATCH-DM score (for participants without prevalent HF) and the TRS-HFDM score (for all participants). The outcome of interest was time to first HF hospitalization. The treatment effect of canagliflozin vs placebo for HF hospitalization was compared across risk strata.RESULTS Among 10,137 participants with available HF data, 1,446 (14.3%) had HF at baseline. Among participants without baseline HF, WATCH-DM risk category did not modify the treatment effect of canagliflozin (vs placebo) on HF hospitalization (P interaction = 0.56). However, the absolute and relative risk reduction with canagliflozin was numerically greater in the high-risk group (cumulative incidence, canagliflozin vs placebo: 8.1% vs 12.7%; HR: 0.62 [95% CI: 0.37-0.93]; P = 0.03; number needed to treat: 22) than in the low-and intermediate-risk groups. When overall study participants were categorized according to the TRS-HF(DM )score, a statistically significant difference in the treatment effect of canagliflozin across risk strata was observed (P interaction = 0.04). Canagliflozin significantly reduced the risk of HF hospitalization by 39% in the high-risk group (HR: 0.61 [95% CI: 0.48-0.78]; P < 0.001; number needed to treat: 20) but not in the intermediate-or low-risk groups.CONCLUSIONS Among participants with T2DM, the WATCH-DM and TRS-HFDM can reliably identify those at high risk for HF hospitalization and most likely to benefit from canagliflozin.

引用

页码：825 / 835

页数：11