Hormonal
Initiation of sodium-glucose cotransporter-2 inhibitors (SGLT-2i) in patients with type 2 diabetes is associated with a significantly lower risk of hospitalization for heart failure and all-cause death compared to other glucose-lowering drugs, representing a class-wide benefit.
For patients with Type 2 Diabetes, starting an SGLT-2 inhibitor (such as canagliflozin, dapagliflozin, or empagliflozin) is associated with a significantly lower risk of heart failure hospitalization and death compared to other common diabetes medications. This benefit appears to apply to the entire class of drugs, not just one specific brand, and extends to patients without established heart disease. Patients should discuss these cardiovascular benefits with their healthcare provider when selecting a treatment plan.
Use of SGLT-2i, versus other glucose-lowering drugs, was associated with lower rates of HHF (hazard ratio, 0.61; 95% confidence interval, 0.51–0.73; P<0.001); death (hazard ratio, 0.49; 95% confidence interval, 0.41–0.57; P<0.001); and HHF or death (hazard ratio, 0.54; 95% confidence interval, 0.48–0.60; P<0.001)... suggesting that the benefits seen with empagliflozin in a randomized trial may be a class effect applicable to a broad population of patients with type 2 diabetes mellitus in real-world practice.
Why this rating
Large-scale, multi-country, propensity-matched observational study (CVD-REAL) with robust sensitivity analyses, though not a randomized controlled trial.
Source
Lower Risk of Heart Failure and Death in Patients Initiated on Sodium-Glucose Cotransporter-2 Inhibitors Versus Other Glucose-Lowering Drugs
Mikhail Kosiborod et al. · Circulation · 2017
DOI 10.1161/circulationaha.117.029190
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