Association between the body mass index and risk of cardiovascular events in sodium‐glucose cotransporter 2 inhibitor users compared with dipeptidyl‐peptidase 4 inhibitor users: A nationwide cohort study in Korea
Authors' conclusion
The association between SGLT2i use and the risk of MACE and HHF was significant in patients with obesity. Baseline BMI was an effect modifier in the association between SGLT2i use and the risk of HHF, with a more pronounced association observed with increasing BMI and with no significant effect modification of the association noted in patients with normal weight.
Study context
- Population
- Patients with T2D, Korean nationwide claims data (September 2014-December 2022), stratified by Asian body mass index (BMI) categories: normal weight 18.5–23 kg/m², overweight 23–25 kg/m², obesity ≥25 kg/m²231,332 propensity score (PS)-matched pairs
- Participants
- 231,332 vs 231,332
- Exposure
- SGLT2i vs DPP4i new users, by baseline BMI
- SGLT2in = 231,332
- DPP4in = 231,332reference
- Outcome
- Co-primary: 4-point major adverse cardiovascular events (MACE) and hospitalization for heart failure (HF) (HHF)
Methodological detailsactive-comparator, new-user, propensity score-matched 1:1, stratified by Asian BMI categories, as-treated exposure definition
- Active-comparator
- New-user
- Propensity score-matched 1:1
- Stratified by Asian BMI categories
- As-treated exposure definition
Main finding
As reported in the abstract
SGLT2i vs DPP4iHazard ratio (95% CI)P value
MACE, overall; no evidence of effect modification by baseline BMI
0.90(0.86–0.95)
p for homogeneity = 0.27HHF, overall
0.53(0.44–0.64)
HHF, obesity (174 675 pairs)
0.47(0.37–0.58)
HHF, overweight (35 372 pairs)
0.49(0.31–0.78)
HHF, normal weight (21 285 pairs); risk not decreased
0.88(0.59–1.31)
- Effect modification of hospitalization for HF (HHF) association by BMI
- p for homogeneity = 0.01
Observational data: associations, not effects.
Original publication
Association between the body mass index and risk of cardiovascular events in sodium‐glucose cotransporter 2 inhibitor users compared with dipeptidyl‐peptidase 4 inhibitor users: A nationwide cohort study in Korea. Diabetes Obes Metab. Published 28 April 2025. doi:10.
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