Sodium Glucose Transporter 2 Inhibitors Versus Metformin on Cardiovascular and Renal Outcomes in Patients With Diabetes With Low Cardiovascular Risk: A Nationwide Cohort Study
Background This study investigated whether initial SGLT2 (sodium‐glucose cotransporter 2) inhibitor‐based treatment is superior to metformin‐based regimens as a primary prevention strategy among low‐risk patients with diabetes. Methods and Results In this nationwide cohort study, a total of 38 496 p...
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| Format: | Article |
| Language: | English |
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Wiley
2024-04-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.123.032397 |
| _version_ | 1797205485137428480 |
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| author | Hao‐Chih Chang Yun‐Yu Chen Tzu‐Ting Kuo Yenn‐Jiang Lin Kuo‐Liong Chien Hung‐Yu Chang Chung‐Lieh Hung Fa‐Po Chung |
| author_facet | Hao‐Chih Chang Yun‐Yu Chen Tzu‐Ting Kuo Yenn‐Jiang Lin Kuo‐Liong Chien Hung‐Yu Chang Chung‐Lieh Hung Fa‐Po Chung |
| author_sort | Hao‐Chih Chang |
| collection | DOAJ |
| description | Background This study investigated whether initial SGLT2 (sodium‐glucose cotransporter 2) inhibitor‐based treatment is superior to metformin‐based regimens as a primary prevention strategy among low‐risk patients with diabetes. Methods and Results In this nationwide cohort study, a total of 38 496 patients with diabetes with low cardiovascular risk were identified (age 62.0±11.6 years, men 50%) from January 1 to December 31, 2016. Patients receiving SGLT2 inhibitors‐based and metformin‐based regimens were 1:2 matched by propensity score. Study outcomes included all‐cause mortality, cardiovascular death, hospitalization for heart failure, stroke, and progression to end‐stage renal disease. Compared with 1928 patients receiving metformin‐based regimens, 964 patients receiving SGLT2 inhibitor‐based regimens had similar all‐cause mortality (hazard ratio [HR], 0.75 [95% CI, 0.51–1.12]), cardiovascular death (HR, 0.69 [95% CI, 0.25–1.89]), hospitalization for heart failure (HR, 1.06 [95% CI, 0.59–1.92]), stroke (HR, 0.78 [95% CI, 0.48–1.27]), and progression to end‐stage renal disease (HR, 0.88 [95% CI, 0.32–2.39]). However, SGLT2 inhibitors were associated with a lower risk of all‐cause mortality (HR, 0.47 [95% CI, 0.23–0.99]; P for interaction=0.008) and progression to end‐stage renal disease (HR, 0.22 [95% CI, 0.06–0.82]; P for interaction=0.04) in patients under the age of 65. Conclusions In comparison to metformin‐based regimens, SGLT2 inhibitor‐based regimens showed a similar risk of all‐cause mortality and adverse cardiorenal events. SGLT2 inhibitors might be considered as first‐line therapy in select low‐risk patients, for example, younger patients with diabetes. |
| first_indexed | 2024-04-24T08:51:52Z |
| format | Article |
| id | doaj.art-4301bd88c7964ba5b51bc3499ae5594a |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-24T08:51:52Z |
| publishDate | 2024-04-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-4301bd88c7964ba5b51bc3499ae5594a2024-04-16T09:33:08ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802024-04-0113810.1161/JAHA.123.032397Sodium Glucose Transporter 2 Inhibitors Versus Metformin on Cardiovascular and Renal Outcomes in Patients With Diabetes With Low Cardiovascular Risk: A Nationwide Cohort StudyHao‐Chih Chang0Yun‐Yu Chen1Tzu‐Ting Kuo2Yenn‐Jiang Lin3Kuo‐Liong Chien4Hung‐Yu Chang5Chung‐Lieh Hung6Fa‐Po Chung7Department of Medicine Taipei Veterans General Hospital Taoyuan Branch Taoyuan TaiwanCardiovascular Research Center, School of Medicine National Yang Ming Chiao Tung University Taipei TaiwanDivision of Cardiovascular Surgery, Department of Surgery Taipei Veterans General Hospital Taipei TaiwanCardiovascular Research Center, School of Medicine National Yang Ming Chiao Tung University Taipei TaiwanInstitute of Epidemiology and Preventive Medicine, College of Public Health National Taiwan University Taipei TaiwanHeart Center Cheng Hsin General Hospital Taipei TaiwanDivision of Cardiology, Department of Internal Medicine MacKay Memorial Hospital Taipei TaiwanCardiovascular Research Center, School of Medicine National Yang Ming Chiao Tung University Taipei TaiwanBackground This study investigated whether initial SGLT2 (sodium‐glucose cotransporter 2) inhibitor‐based treatment is superior to metformin‐based regimens as a primary prevention strategy among low‐risk patients with diabetes. Methods and Results In this nationwide cohort study, a total of 38 496 patients with diabetes with low cardiovascular risk were identified (age 62.0±11.6 years, men 50%) from January 1 to December 31, 2016. Patients receiving SGLT2 inhibitors‐based and metformin‐based regimens were 1:2 matched by propensity score. Study outcomes included all‐cause mortality, cardiovascular death, hospitalization for heart failure, stroke, and progression to end‐stage renal disease. Compared with 1928 patients receiving metformin‐based regimens, 964 patients receiving SGLT2 inhibitor‐based regimens had similar all‐cause mortality (hazard ratio [HR], 0.75 [95% CI, 0.51–1.12]), cardiovascular death (HR, 0.69 [95% CI, 0.25–1.89]), hospitalization for heart failure (HR, 1.06 [95% CI, 0.59–1.92]), stroke (HR, 0.78 [95% CI, 0.48–1.27]), and progression to end‐stage renal disease (HR, 0.88 [95% CI, 0.32–2.39]). However, SGLT2 inhibitors were associated with a lower risk of all‐cause mortality (HR, 0.47 [95% CI, 0.23–0.99]; P for interaction=0.008) and progression to end‐stage renal disease (HR, 0.22 [95% CI, 0.06–0.82]; P for interaction=0.04) in patients under the age of 65. Conclusions In comparison to metformin‐based regimens, SGLT2 inhibitor‐based regimens showed a similar risk of all‐cause mortality and adverse cardiorenal events. SGLT2 inhibitors might be considered as first‐line therapy in select low‐risk patients, for example, younger patients with diabetes.https://www.ahajournals.org/doi/10.1161/JAHA.123.032397low cardiovascular riskmetforminsodium‐glucose cotransporter 2 inhibitorstype 2 diabetes |
| spellingShingle | Hao‐Chih Chang Yun‐Yu Chen Tzu‐Ting Kuo Yenn‐Jiang Lin Kuo‐Liong Chien Hung‐Yu Chang Chung‐Lieh Hung Fa‐Po Chung Sodium Glucose Transporter 2 Inhibitors Versus Metformin on Cardiovascular and Renal Outcomes in Patients With Diabetes With Low Cardiovascular Risk: A Nationwide Cohort Study Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease low cardiovascular risk metformin sodium‐glucose cotransporter 2 inhibitors type 2 diabetes |
| title | Sodium Glucose Transporter 2 Inhibitors Versus Metformin on Cardiovascular and Renal Outcomes in Patients With Diabetes With Low Cardiovascular Risk: A Nationwide Cohort Study |
| title_full | Sodium Glucose Transporter 2 Inhibitors Versus Metformin on Cardiovascular and Renal Outcomes in Patients With Diabetes With Low Cardiovascular Risk: A Nationwide Cohort Study |
| title_fullStr | Sodium Glucose Transporter 2 Inhibitors Versus Metformin on Cardiovascular and Renal Outcomes in Patients With Diabetes With Low Cardiovascular Risk: A Nationwide Cohort Study |
| title_full_unstemmed | Sodium Glucose Transporter 2 Inhibitors Versus Metformin on Cardiovascular and Renal Outcomes in Patients With Diabetes With Low Cardiovascular Risk: A Nationwide Cohort Study |
| title_short | Sodium Glucose Transporter 2 Inhibitors Versus Metformin on Cardiovascular and Renal Outcomes in Patients With Diabetes With Low Cardiovascular Risk: A Nationwide Cohort Study |
| title_sort | sodium glucose transporter 2 inhibitors versus metformin on cardiovascular and renal outcomes in patients with diabetes with low cardiovascular risk a nationwide cohort study |
| topic | low cardiovascular risk metformin sodium‐glucose cotransporter 2 inhibitors type 2 diabetes |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.123.032397 |
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