Introduction Sodium-glucose cotransporter-2 inhibitors (SGLT2I) and dipeptidyl-peptidase-4 inhibitors (DPP4I) are increasingly prescribed for type 2 diabetes mellitus patients. However, there are few population-based studies comparing their effects on incident heart failure (HF) or acute myocardial infarction (AMI). Therefore, the present study aims to compare the occurrence of major cardiovascular adverse events in SGLT2I and DPP4I users to evaluate their cardiovascular protective effects in a Chinese population.
Methods This was a population-based retrospective cohort study using the electronic health record database in Hong Kong, including type 2 diabetes mellitus patients receiving either SGLT2I or DPP4I between January 1st, 2015 to December 31st, 2020. Propensity-score matching was performed in a 1:2 ratio based on demographics, past comorbidities and medications using nearest-neighbor matching. Multivariate Cox regression analysis were used to identify significant predictors for new-onset HF or AMI, cardiovascular and all-cause mortality.
Results A total of 48875 and 49508 patients were included in the HF and AMI cohorts, respectively. After propensity score matching, SGLT2I use was associated with a lower risk of new-onset HF (HR: 0.41[0.27, 0.62], P<0.0001) and MI (HR: 0.52, 95% CI: [0.36, 0.77], P=0.0009) in multivariable Cox models adjusted for demographics and past comorbidities compared to DPP4I use. SGLT2I users also had lower risks of all-cause and cardiovascular mortality (HR<1, P<0.001).
Conclusions SGLT2 inhibitors are protective against adverse cardiovascular events including new-onset HF, MI, cardiovascular and all-cause mortality. The prescription of antidiabetic agents should be personalized, taking into consideration individual cardiovascular and metabolic risk profiles in addition to drug-drug interactions.
Conflict of Interest None
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