Abstract
Aims
To assess the association between the use of sodium-glucose cotransporter-2 (SGLT2i)
and cardiovascular outcomes and death as a function of obesity among patients with
type 2 diabetes.
Methods
This new-user, active-comparator cohort study used U.K.’s Clinical Practice Research
Datalink linked to Hospital Episodes Statistics repository and Office for National
Statistics. The cohort included 34,128 new-users of SGLT2i matched 1:1 to 34,128 new-users
of dipeptidyl peptidase-4 inhibitors (DPP-4i) on body mass index and propensity score.
Cox proportional hazards models were used to estimate hazard ratios (HRs) with 95%
confidence intervals (CIs) of major adverse cardiovascular events (MACE), overall
and in body mass index (BMI) categories (≤24.9 kg/m2, 25.0–29.9 kg/m2, 30.0–39.9 kg/m2, ≥40 kg/m2). Secondary outcomes included all-cause mortality and hospitalization for heart failure.
Results
SGLT2i were associated with a decreased risk of MACE (HR: 0.78, 95 %CI: 0.69–0.88)
compared to DPP-4i. This decreased risk was most pronounced among obese and severely
obese patients (HR: 0.77, 95 %CI: 0.66–0.91; HR: 0.67, 95% CI: 0.49–0.91, respectively)
but not among overweight patients (HR: 0.94, 95 %CI: 0.73–1.22). Similar patterns
were observed for cardiovascular mortality, all-cause mortality, and heart failure.
Conclusion
Compared with DPP-4i, the cardioprotective effect associated with SGLT2i is stronger
among patients with higher BMI.
Keywords
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Article info
Publication history
Published online: September 24, 2022
Accepted:
September 20,
2022
Received in revised form:
September 9,
2022
Received:
August 5,
2022
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
