SGLT2 Inhibitors: Effect on Myocardial Infarction and Stroke in Type 2 Diabetes.

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  • Additional Information
    • Source:
      Publisher: Oxford University Press Country of Publication: United States NLM ID: 0375362 Publication Model: Print Cited Medium: Internet ISSN: 1945-7197 (Electronic) Linking ISSN: 0021972X NLM ISO Abbreviation: J Clin Endocrinol Metab Subsets: MEDLINE
    • Publication Information:
      Publication: 2017- : New York : Oxford University Press
      Original Publication: Springfield, Ill. : Charles C. Thomas
    • Subject Terms:
      Diabetes Mellitus, Type 2*/complications ; Diabetes Mellitus, Type 2*/drug therapy ; Diabetes Mellitus, Type 2*/chemically induced ; Sodium-Glucose Transporter 2 Inhibitors*/adverse effects ; Myocardial Infarction*/epidemiology ; Myocardial Infarction*/prevention & control ; Myocardial Infarction*/chemically induced ; Stroke*/epidemiology ; Stroke*/etiology ; Stroke*/prevention & control ; Cardiovascular System* ; Atherosclerosis*/etiology ; Cardiovascular Diseases*/epidemiology ; Cardiovascular Diseases*/etiology ; Cardiovascular Diseases*/prevention & control; Humans
    • Abstract:
      Background: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have recently been recommended as preferred agents for management of hyperglycemia in type 2 diabetes, primarily based on their ability to reduce a composite of major cardiovascular adverse events (3-point major adverse cardiovascular events [MACE]), predominantly by reducing cardiovascular death. However, reduction of the individual components, myocardial infarction (MI), or stroke (fatal and nonfatal) events have not been well explored.
      Methods: In this meta-analysis, we included data available from cardiovascular outcome trials only, which were event-driven, randomized, and placebo-controlled. Pooled efficacy outcomes included Mantel Haenszel (MH) risk ratio using fixed model (with 95% CI) for fatal and nonfatal MI, stroke, and total MI and stroke.
      Findings: Data from 4 eligible trials included 42,568 subjects. Total MACE, MI, and stroke were reported in 4176, 2157, and 1288 subjects, respectively. SGLT2is did not significantly reduce either MI or stroke individually or in totality. The MH risk ratio (95% CI) for fatal and nonfatal MI and stroke with different SGLT2is was found to be 0.93 (95% CI, 0.85-1.01) and 1.00 (95% CI, 0.89-1.11), respectively. For total atherosclerotic cardiovascular disease (ASCVD) events, MH risk ratio (95% CI) was 0.95 (95% CI, 0.89-1.02). For all nonfatal ASCVD (combined nonfatal MI and nonfatal stroke), MH risk ratio (95% CI) was 0.94 (95% CI, 0.88-1.02).
      Interpretation: SGLT2is reduce MACE without any discernable significant reduction of the incidence of MI or stroke (fatal and nonfatal), probably implicating mechanisms unrelated to anti-atherogenic effects.
      (© The Author(s) 2023. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For permissions, please e-mail: [email protected].)
    • Comments:
      Comment in: J Clin Endocrinol Metab. 2023 Apr 15;:. (PMID: 37061813)
    • Contributed Indexing:
      Keywords: ASCVD; SGLT 2 inhibitors; myocardial infarction; stroke
    • Accession Number:
      0 (Sodium-Glucose Transporter 2 Inhibitors)
    • Publication Date:
      Date Created: 20230301 Date Completed: 20230717 Latest Revision: 20231018
    • Publication Date:
      20240628
    • Accession Number:
      10.1210/clinem/dgad113
    • Accession Number:
      36856812