Use of sodium glucose cotransporter 2 (SGLT2) inhibitors for type 2 diabetes is associated with a reduced risk for heart failure, but not a reduced risk for major cardiovascular events, compared with use of dipeptidyl peptidase 4 (DPP4) inhibitors, according to a study published online in The BMJ.

Björn Pasternak, M.D., Ph.D., from the Karolinska Institutet in Stockholm, and colleagues used data from nationwide registers in Denmark, Norway, and Sweden (April 2013 to December 2016) to identify 20,983 new users of SGLT2 inhibitors and 20,983 new users of DPP4 inhibitors. Participants were aged 35 to 84 years and were matched by age, sex, history of major cardiovascular disease, and propensity score.

The researchers found that during follow-up, 467 SGLT2 inhibitor users (incidence rate, 17 events per 1,000 person-years) and 662 DPP4 inhibitor users (18 events per 1,000 person-years) had a major cardiovascular event. Specifically, 130 (4.7 events per 1,000 person-years) and 265 (7.1 events per 1,000 person-years), respectively, had a heart failure event. For major cardiovascular events, the hazard ratio was 0.94 (95 percent confidence interval [CI], 0.84 to 1.06); the hazard ratio was 0.66 (95 percent CI, 0.53 to 0.81) for heart failure. Findings were similar among subgroups of patients with and without a history of major cardiovascular disease or heart failure. Comparing SGLT2 inhibitors with DPP4 inhibitors, hazard ratios were 0.99 (95 percent CI, 0.85 to 1.17) for myocardial infarction, 0.94 (95 percent CI, 0.77 to 1.15) for stroke, 0.84 (95 percent CI, 0.65 to 1.08) for cardiovascular death, and 0.80 (95 percent CI, 0.69 to 0.92) for any-cause death.

"These data help inform patients, practitioners, and authorities regarding the cardiovascular effectiveness of SGLT2 inhibitors in routine clinical practice," the authors write.

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