Cardiovascular outcomes with SGLT2 inhibitors versus DPP4 inhibitors and GLP-1 receptor agonists in patients with heart failure with reduced and preserved ejection fraction
Authors' conclusion
Bias from residual confounding cannot be ruled out. Use of SGLT2i was associated with reduced risk of HHF against DPP4i and GLP-1RA, reduced risk of MI or stroke against DPP4i within the HFrEF subgroup, and comparable risk of MI or stroke against GLP-1RA. Notably, the magnitude of cardiovascular benefit conferred by SGLT2i was similar among patients with HFrEF and HFpEF.
Study context
- Population
- T2D patients with HFrEF or HFpEF, Medicare fee-for-service data (2013–2019)four pair-wise cohorts
- Exposure
- SGLT2i vs DPP4i and vs GLP-1 RA in T2D with HFrEF or HFpEF
- Outcome
- (1) Hospitalization for HF (hospitalization for heart failure (HHF)) and (2) myocardial infarction (MI) or stroke hospitalizations
Methodological detailsfour pair-wise comparison cohorts, new-user (initiator) design, inverse probability of treatment weighting
- Four pair-wise comparison cohorts
- New-user (initiator) design
- Inverse probability of treatment weighting
Main finding
As reported in the abstract
Adjusted hazard ratio (95% CI)
SGLT2ivs DPP4iHHF; HFrEF (cohort 1a; n = 13,882)
0.67(0.63–0.72)
SGLT2ivs DPP4iMI or stroke; HFrEF (cohort 1a)
0.86(0.75–0.99)
SGLT2ivs GLP-1RAHHF; HFrEF (cohort 1b; n = 6951)
0.86(0.79–0.93)
SGLT2ivs GLP-1RAMI or stroke; HFrEF (cohort 1b)
1.02(0.85–1.22)
SGLT2ivs DPP4iHHF; HFpEF (cohort 2a; n = 17,493)
0.65(0.61–0.69)
SGLT2ivs DPP4iMI or stroke; HFpEF (cohort 2a)
0.90(0.79–1.02)
SGLT2ivs GLP-1RAHHF; HFpEF (cohort 2b; n = 9053)
0.89(0.83–0.96)
SGLT2ivs GLP-1RAMI or stroke; HFpEF (cohort 2b)
0.97(0.83–1.14)
Observational data: associations, not effects.
Secondary outcomes
Secondary outcomes (e.g., all-cause mortality) and sensitivity analyses
- Results were robust across secondary outcomes and sensitivity analyses
Original publication
Cardiovascular outcomes with SGLT2 inhibitors versus DPP4 inhibitors and GLP-1 receptor agonists in patients with heart failure with reduced and preserved ejection fraction. Cardiovasc Diabetol. Published 10 March 2023. doi:10.
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