Three Diabetes Meds Found to Reduce Heart Failure Hospitalizations

Dr Mikhail Kosiborod, Saint Luke's Mid America Heart Institute

Mikhail Kosiborod, MD

New research suggests that patients with type 2 diabetes (T2D) who are treated with sodium-glucose co-transporter-2 inhibitor (SGLT-2i) medicines experience a significantly lower risk of hospitalizations for heart failure and death than those treated with other glucose lowering drugs.

To determine the effect of SGLT-2i medicines on cardiovascular health, a team of researchers led by Mikhail Kosiborod, MD, Saint Luke’s Mid America Heart Institute, tested three treatments — canagliflozin, dapagliflozin, and empagliflozin. Data was collected from more than 300,000 patients across 5 European countries and the US in the CVD-REAL study, where 87% of the patient cohort did not have a known history of cardiovascular disease.

Across the broad population of patients with T2D, treatment with the three medications was associated with a 39% lower risk of hospitalization for heart failure and a 51% lower risk of death from any cause, compared with other T2D medicines.

“T2D remains a major risk factor for cardiovascular disease and overall mortality despite advances in treatment,” Kosiborod said. “The CVD-REAL study results suggest that the SGLT-2i medicines may have a significant impact on reducing those risks and may improve overall outcomes in a much broader population of patients with T2D than previously thought.”

Among patients treated with SGLT-2i, the majority in the US received canagliflozin — a diabetes medication marketed by Janssen Pharmaceuticals that has recently been identified by the FDA as increasing the risk of leg and foot amputations. The majority of patients in Europe received dapagliflozin, a T2D drug developed by Bristol-Myers Squibb in partnership with AstraZeneca, who sponsored the study.

Lower risks of hospitalization for heart failure and death associated with SGLT-2i use were seen both in the US and Europe, suggesting that these potential benefits may represent a class effect.

The CVD-REAL study is ongoing and future analyses will be conducted using this dataset and data from additional countries. Study data was obtained from medical records, claims databases and national registers. While the study is sponsored by AstraZeneca, it was validated by the independent academic statistical group at Saint Luke’s Mid America Heart Institute in Kansas City, Missouri.

CVD-REAL is a large study with a robust propensity-matching technique, however, given its observational nature and the possibility of residual, unmeasured confounding factors cannot be definitively excluded, according to a statement from the organization.

Diabetes affects around 415 million adults across the globe — a number that is forecasted to rise to 642 million by 2040 – and 50% of deaths in people with T2D are caused by cardiovascular disease. People with T2D face a much higher risk of heart failure and death than those without diabetes, and the prognosis for patients with diabetes that develop heart failure is especially ominous.

“There is a substantial need to develop treatments that not only lower blood glucose levels, but also reduce the risk of cardiovascular complications, including heart failure,” Kosiborod said.