Canadian researchers have added to the considerable raft of evidence in support of thee use of SGLT2 inhibitor drugs as a means to reduce cardiovascular events. In a large study the risk of cardiovascular events observed in subjects treated with sodium glucose cotransporter 2 (SGLT2) inhibitors and those receiving dipeptidyl peptidase-4 (DPP-4) inhibitors was compared among people with type 2 diabetes in a real world context of clinical practice.209 867 new users of a SGLT2 inhibitor matched to 209 867 users of a DPP-4 inhibitor on time-conditional propensity score and followed for a mean of nearly one year. The primary outcome was major adverse cardiovascular events (MACE, a composite of myocardial infarction, ischaemic stroke, or cardiovascular death). Other secondary outcomes were the individual components of MACE, heart failure, and all cause mortality. SGLT2 inhibitors were associated with decreased risks of MACE (incidence rate per 1000 person years: 11.4 v 16.5; hazard ratio 0.76, 95% confidence interval 0.69 to 0.84), myocardial infarction (5.1 v 6.4; 0.82, 0.70 to 0.96), cardiovascular death (3.9 v 7.7; 0.60, 0.54 to 0.67), heart failure (3.1 v 7.7; 0.43, 0.37 to 0.51), and all cause mortality (8.7 v 17.3; 0.60, 0.54 to 0.67), although the effects of SGLT2 inhibitors were more modest for reduction in ischaemic stroke (2.6 v 3.5; 0.85, 0.72 to 1.01). Similar benefits for MACE were observed with three different SGLT2 agents.
It seems that the evidence continues to accumulate – the question remains as to why the evidence is so difficult to translate into changes of prescribing practices? See full details of the study here.