Please use this identifier to cite or link to this item: https://doi.org/10.1186/s12933-021-01345-z
Title: Cardiovascular outcomes with sodium–glucose cotransporter-2 inhibitors vs other glucose-lowering drugs in 13 countries across three continents: analysis of CVD-REAL data
Authors: 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.
Jørgensen, 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
Carstensen, Bendix
Jørgensen, Marit E.
Lam, Carolyn S. P. 
Kendrick, Rachel
Belli, Wesley
Wittbrodt, Eric
Franch-Nadal, Josep
Noguchi, Yusuke
Tangri, Navdeep
Kohsaka, Shun
Kim, Dae Jung
Shaw, Jonathan E.
Andersson-Sundell, Karolina
Goh, Su-Yen 
Chiang, Chern-En
Eriksson, Johan G. 
Zaccardi, Francesco
Chen, Hungta
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
Hoti, Fabian
Christopher, Solomon
Vehkala, Minna
Keywords: Cardiovascular outcomes
Heart failure
Sodium–glucose cotransporter-2 inhibitors
Type 2 diabetes
Issue Date: 31-Jul-2021
Publisher: BioMed Central Ltd
Citation: 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., Jørgensen, 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, Carstensen, Bendix, Jørgensen, Marit E., Lam, Carolyn S. P., Kendrick, Rachel, Belli, Wesley, Wittbrodt, Eric, Franch-Nadal, Josep, Noguchi, Yusuke, Tangri, Navdeep, Kohsaka, Shun, Kim, Dae Jung, Shaw, Jonathan E., Andersson-Sundell, Karolina, Goh, Su-Yen, Chiang, Chern-En, Eriksson, Johan G., Zaccardi, Francesco, Chen, Hungta, 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, Hoti, Fabian, Christopher, Solomon, Vehkala, Minna (2021-07-31). Cardiovascular outcomes with sodium–glucose cotransporter-2 inhibitors vs other glucose-lowering drugs in 13 countries across three continents: analysis of CVD-REAL data. Cardiovascular Diabetology 20 (1) : 159. ScholarBank@NUS Repository. https://doi.org/10.1186/s12933-021-01345-z
Rights: Attribution 4.0 International
Abstract: 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 © 2021, The Author(s).
Source Title: Cardiovascular Diabetology
URI: https://scholarbank.nus.edu.sg/handle/10635/233558
ISSN: 1475-2840
DOI: 10.1186/s12933-021-01345-z
Rights: Attribution 4.0 International
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