Cardiovascular Mortality and Morbidity in Patients With Type 2 Diabetes Following Initiation of Sodium-Glucose Cotransporter-2 Inhibitors Versus Other Glucose-Lowering Drugs (CVD-REAL Nordic): A Multinational Observational Analysis

August 3, 2017. This real-world, clinical practice-based study was designed to compare cardiovascular (CV) mortality and morbidity in new users of sodium-glucose cotransporter-2 (SGLT-2) inhibitors compared with new users of other glucose-lowering drugs. The CVD-REAL Nordic multinational observational analysis evaluated data for all patients who filled a prescription for glucose-lowering drugs between 2012 and 2015 in Denmark, Norway, and Sweden. Propensity scoring was used to match SGLT-2 inhibitor users with 3 users of other glucose-lowering drugs (n=22,830 and n=68,490, respectively). Outcomes evaluated were CV mortality, major adverse CV events, inpatient or outpatient hospital events for heart failure, nonfatal myocardial infarction, nonfatal stroke, and atrial fibrillation. Investigators also assessed the incidence of severe hypoglycemia. Compared with other glucose-lowering drugs, SGLT-2 inhibitor use was associated with decreased CV mortality risk (hazard ratio [HR] 0.53), major adverse CV events (0.78), and hospital events for heart failure (0.70; P<0.0001 for all). No significant differences based on drug type were observed for nonfatal myocardial infarction, nonfatal stroke, or atrial fibrillation.  Additionally, compared with other glucose-lowering drugs, use of SGLT-2 inhibitors was associated with a decreased risk of severe hypoglycemia (HR 0.76; P=0.001). Total SGLT-2 inhibitor exposure was 94% dapagliflozin, 5% empagliflozin, and 1% canagliflozin. Read the full study abstract here.