Sustained Use of SGLT2 Inhibitors and Cardiovascular Outcomes in Older Adults: A Landmark Cohort Study
Authors' conclusion
Among older adults who had maintained treatment for ≥ 6 months, sustained SGLT2i use was associated with lower subsequent risks of heart failure hospitalisation and MACE. Heart failure associations were directionally consistent across BMI strata, whereas BMI-related MACE heterogeneity was exploratory
Study context
- Population
- Adults aged ≥ 65 years with T2D who maintained SGLT2i or DPP-4i for ≥ 6 months, Japan
- Participants
- 24,380 adults
- Exposure
- Sustained SGLT2i vs DPP-4i
- SGLT2in = 4,223
- DPP-4in = 20,157reference
- Outcome
- HF hospitalisation; MACE:
- MI
- Stroke
- All-cause mortality
Methodological detailsnationwide-scale, linked claims and health examination data, inverse probability of treatment and censoring weighting, weighted discrete-time hazard models
- Nationwide-scale
- Linked claims and health examination data
- Inverse probability of treatment and censoring weighting
- Weighted discrete-time hazard models
Main finding
As reported in the abstract
Each group vs DPP-4iEstimate (95% CI)
SGLT2i
HR (HF hospitalisation) 0.775(0.628–0.958)
SGLT2i
HR (MACE) 0.848(0.753–0.955)
Observational data: associations, not effects.
Further findings
Stroke
- Stroke hazard was lower, HR
- 0.834 (0.721-0.965) (95% CI)
MI and all-cause mortality
- MI and all-cause mortality were not clearly different
HF hospitalisation across body mass index (BMI) strata
- Association directionally consistent across BMI strata; p for interaction
- 0.953
MACE across BMI strata
- MACE estimates differed across BMI strata; p for interaction
- 0.007
- Exploratory
MACE, lowest BMI group (< 22 kg/m²)
- No clear association in lowest BMI group, HR
- 1.226 (0.931-1.615) (95% CI)
- Exploratory
Original publication
Sustained Use of SGLT2 Inhibitors and Cardiovascular Outcomes in Older Adults: A Landmark Cohort Study. Diabetes Obes Metab. Published 28 July 2026. doi:10.
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