Abstract
Objective
The primary prevention of major adverse cardiovascular events by sodium-glucose cotransporter-2 inhibitors (SGLT2i) in patients with type 2 diabetes without cardiovascular disease (CVD) remains unclear.
Research Design and Methods
We used propensity score matching to identify 9520 pairs of SGLT2i users compared with DPP-4 inhibitor users in patients with hypertension and 3496 pairs in patients without hypertension using data from Taiwan’s National Health Insurance Research Database for the period between January 1, 2008, and December 31, 2021. Cox proportional hazards models were used to assess the risk of outcomes between SGLT2i and DPP-4 inhibitor users.
Results
Mean follow-up was 2.81 years for the cohort of patients with hypertension and 2.79 years for those without hypertension. Compared to the use of DPP-4 inhibitors, the use of SGLT2i was significantly associated with a reduced risk of developing stroke [aHR (95% CI) 0.56(0.47–0.66)], coronary artery disease [0.80(0.69–0.94)], heart failure [0.31(0.24–0.41)], and major adverse cardiovascular events (MACE) [0.62(0.56–0.70)] in patients with hypertension. Additionally, in patients without hypertension, SGLT2i use was significantly associated with a reduced risk of developing atrial fibrillation [aHR (95% CI) 0.48(0.25–0.91)].
Conclusions
This nationwide cohort study demonstrates that in T2D patients without cardiovascular disease, SGLT2i use is associated with a lower risk of coronary heart disease, stroke, heart failure, and MACE in those with hypertension. In patients without hypertension, SGLT2i use was linked to a reduced risk of atrial fibrillation, suggesting its potential role in the primary prevention of cardiovascular events for T2D patients.
Topic
JGIM
Author Descriptions
Dr. Yen’s Clinic, No. 15, Shanying Road, Gueishan District, Taoyuan City, 33354, Taiwan
Fu-Shun Yen MD
Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, No. 110, Sec. 1, Jianguo N. Rd., South District, Taichung City, 40201, Taiwan
James Cheng-Chung Wei PhD
Institute of Medicine, Chung Shan Medical University, Taichung City, 40201, Taiwan
James Cheng-Chung Wei PhD
Graduate Institute of Integrated Medicine, China Medical University, Taichung City, 40402, Taiwan
James Cheng-Chung Wei PhD
Department of Internal Medicine, Taitung Hospital, Ministry of Health and Welfare, Taitung City, Taiwan
Yao-Min Hung PhD
Master Program in Biomedicine, College of Science and Engineering, National Taitung University, Taitung City, Taiwan
Yao-Min Hung PhD
College of Health and Nursing, Meiho University, Pingtung City, Taiwan
Yao-Min Hung PhD
Management Office for Health Data, China Medical University Hospital, Taichung City, Taiwan
Pei-Yun Li MS
College of Medicine, China Medical University, Taichung City, Taiwan
Pei-Yun Li MS
Institute of Population Health Sciences, National Health Research Institutes, 35 Keyan Road, Zhunan, Miaoli County, 35053, Taiwan
Chih-Cheng Hsu MD
Department of Health Services Administration, China Medical University, No. 100, Sec. 1, Jingmao Rd., Beitun Dist, Taichung City, 40402, Taiwan
Chih-Cheng Hsu MD
Department of Family Medicine, Min-Sheng General Hospital, 168 Ching Kuo Road, Taoyuan City, 33044, Taiwan
Chih-Cheng Hsu MD
National Center for Geriatrics and Welfare Research, National Health Research Institutes, No. 8, Xuefu W. Rd., Huwei Township, Yunlin County, 632007, Taiwan
Chih-Cheng Hsu MD
Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, No.155, Sec.2, Linong Street, Taipei City, 11221, Taiwan
Chii-Min Hwu MD
Section of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Road, Beitou District, Taipei City, 11217, Taiwan
Chii-Min Hwu MD
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