학술논문
Cardiovascular outcomes with sodium-glucose cotransporter-2 inhibitors vs other glucose-lowering drugs in 13 countries across three continents: analysis of CVD-REAL data
Document Type
Clinical report
Author
Khunti, Kamlesh; Kosiborod, Mikhail; Kim, Dae Jung; Kohsaka, Shun; Lam, Carolyn S. P.; Goh, Su-Yen; Chiang, Chern-En; Shaw, Jonathan E.; Cavender, Matthew A.; Tangri, Navdeep; Franch-Nadal, Josep; Holl, Reinhard W.; Jargensen, Marit E.; Norhammar, Anna; Eriksson, Johan G.; Zaccardi, Francesco; Karasik, Avraham; Magliano, Dianna J.; Thuresson, Marcus; Chen, Hungta; Wittbrodt, Eric; Bodegård, Johan; Surmont, Filip; Fenici, Peter; Wilding, John P.; Birkeland, Kåre; Jargensen, Marit Eika; Gulseth, Hanne Lavdal; Carstensen, Bendix; Bollow, Esther; Rodríguez, Luis Alberto García; Shaw, Jonathan; Arnold, Suzanne; Kendrick, Rachel; Belli, Wesley; Wittbrodt, Eric T.; Saathoff, Matthias; Noguchi, Yusuke; Tan, Donna; Williams, Maro; Lee, Hye Won; Greenbloom, Maya; Kaidanovich-Beilin, Oksana; Andersson-Sundell, Karolina; Yeo, Khung Keong; Bee, Yong Mong; Khoo, Joan; Koong, Agnes; Lau, Yee How; Gao, Fei; Tan, Wee Boon; Kadir, Hanis Abdul; Ha, Kyoung Hwa; Lee, Jinhee; Chodick, Gabriel; Cohen, Cheli Melzer; Whitlock, Reid; Soriano, Lucia Cea; Cantero, Oscar Fernándex; Menzin, Jordan A.; Guthrie, Matthew; Ilomaki, Jennie; Magliano, Dianna; Hoti, Fabian; Christopher, Solomon; Vehkala, Minna
Source
Cardiovascular Diabetology. July 31, 2021, Vol. 20 Issue 1
Subject
Language
English
Abstract
Author(s): Kamlesh Khunti[sup.1], Mikhail Kosiborod[sup.2,3,4], Dae Jung Kim[sup.5], Shun Kohsaka[sup.6], Carolyn S. P. Lam[sup.7,8,9], Su-Yen Goh[sup.10], Chern-En Chiang[sup.11,12], Jonathan E. Shaw[sup.13], Matthew A. Cavender[sup.14], Navdeep Tangri[sup.15], Josep Franch-Nadal[sup.16], Reinhard W. [...]
Background Randomized, controlled cardiovascular outcome trials may not be fully representative of the management of patients with type 2 diabetes across different geographic regions. We conducted analyses of data from the multinational CVD-REAL consortium to determine the association between initiation of sodium-glucose cotransporter-2 inhibitors (SGLT-2i) and cardiovascular outcomes, including subgroup analyses based on patient characteristics. Methods De-identified health records from 13 countries across three continents were used to identify patients newly-initiated on SGLT-2i or other glucose-lowering drugs (oGLDs). Propensity scores for SGLT-2i initiation were developed in each country, with 1:1 matching for oGLD initiation. In the matched groups hazard ratios (HRs) for hospitalization for heart failure (HHF), all-cause death (ACD), the composite of HHF or ACD, myocardial infarction (MI) and stroke were estimated by country, and pooled using a weighted meta-analysis. Multiple subgroup analyses were conducted across patient demographic and clinical characteristics to examine any heterogeneity in treatment effects. Results Following matching, 440,599 new users of SGLT-2i and oGLDs were included in each group. Mean follow-up time was 396 days for SGLT-2i initiation and 406 days for oGLDs initiation. SGLT-2i initiation was associated with a lower risk of HHF (HR: 0.66, 95%CI 0.58-0.75; p < 0.001), ACD (HR: 0.52, 95%CI 0.45-0.60; p < 0.001), the composite of HHF or ACD (HR: 0.60, 95%CI 0.53-0.68; p < 0.001), MI (HR: 0.85, 95%CI 0.78-0.92; p < 0.001), and stroke (HR: 0.78, 95%CI 0.72-0.85; p < 0.001); regardless of patient characteristics, including established cardiovascular disease, or geographic region. Conclusions This CVD-REAL study extends the findings from the SGLT-2i clinical trials to the broader setting of an ethnically and geographically diverse population, and across multiple subgroups. Trial registration NCT02993614 Keywords: Sodium-glucose cotransporter-2 inhibitors, Cardiovascular outcomes, Heart failure, Type 2 diabetes
Background Randomized, controlled cardiovascular outcome trials may not be fully representative of the management of patients with type 2 diabetes across different geographic regions. We conducted analyses of data from the multinational CVD-REAL consortium to determine the association between initiation of sodium-glucose cotransporter-2 inhibitors (SGLT-2i) and cardiovascular outcomes, including subgroup analyses based on patient characteristics. Methods De-identified health records from 13 countries across three continents were used to identify patients newly-initiated on SGLT-2i or other glucose-lowering drugs (oGLDs). Propensity scores for SGLT-2i initiation were developed in each country, with 1:1 matching for oGLD initiation. In the matched groups hazard ratios (HRs) for hospitalization for heart failure (HHF), all-cause death (ACD), the composite of HHF or ACD, myocardial infarction (MI) and stroke were estimated by country, and pooled using a weighted meta-analysis. Multiple subgroup analyses were conducted across patient demographic and clinical characteristics to examine any heterogeneity in treatment effects. Results Following matching, 440,599 new users of SGLT-2i and oGLDs were included in each group. Mean follow-up time was 396 days for SGLT-2i initiation and 406 days for oGLDs initiation. SGLT-2i initiation was associated with a lower risk of HHF (HR: 0.66, 95%CI 0.58-0.75; p < 0.001), ACD (HR: 0.52, 95%CI 0.45-0.60; p < 0.001), the composite of HHF or ACD (HR: 0.60, 95%CI 0.53-0.68; p < 0.001), MI (HR: 0.85, 95%CI 0.78-0.92; p < 0.001), and stroke (HR: 0.78, 95%CI 0.72-0.85; p < 0.001); regardless of patient characteristics, including established cardiovascular disease, or geographic region. Conclusions This CVD-REAL study extends the findings from the SGLT-2i clinical trials to the broader setting of an ethnically and geographically diverse population, and across multiple subgroups. Trial registration NCT02993614 Keywords: Sodium-glucose cotransporter-2 inhibitors, Cardiovascular outcomes, Heart failure, Type 2 diabetes