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Cardiovascular Events Associated With SGLT-2 Inhibitors Versus Other Glucose-Lowering Drugs: The CVD-REAL 2 Study

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dc.contributor.authorKosiborod, M-
dc.contributor.authorLam, CSP-
dc.contributor.authorKohsaka, S-
dc.contributor.authorKim, DJ-
dc.contributor.authorKarasik, A-
dc.contributor.authorShaw, J-
dc.contributor.authorTangri, N-
dc.contributor.authorGoh, SY-
dc.contributor.authorThuresson, M-
dc.contributor.authorChen, H-
dc.contributor.authorSurmont, F-
dc.contributor.authorHammar, N-
dc.contributor.authorFenici, P-
dc.contributor.authorCVD-REAL Investigators and Study Group-
dc.date.accessioned2019-11-13T04:27:36Z-
dc.date.available2019-11-13T04:27:36Z-
dc.date.issued2018-
dc.identifier.issn0735-1097-
dc.identifier.urihttp://repository.ajou.ac.kr/handle/201003/17592-
dc.description.abstractBACKGROUND: Randomized trials demonstrated a lower risk of cardiovascular (CV) events with sodium-glucose cotransporter-2 inhibitors (SGLT-2i) in patients with type 2 diabetes (T2D) at high CV risk. Prior real-world data suggested similar SGLT-2i effects in T2D patients with a broader risk profile, but these studies focused on heart failure and death and were limited to the United States and Europe.
OBJECTIVES: The purpose of this study was to examine a broad range of CV outcomes in patients initiated on SGLT-2i versus other glucose-lowering drugs (oGLDs) across 6 countries in the Asia Pacific, the Middle East, and North American regions.
METHODS: New users of SGLT-2i and oGLDs were identified via claims, medical records, and national registries in South Korea, Japan, Singapore, Israel, Australia, and Canada. Propensity scores for SGLT-2i initiation were developed in each country, with 1:1 matching. Hazard ratios (HRs) for death, hospitalization for heart failure (HHF), death or HHF, MI, and stroke were assessed by country and pooled using weighted meta-analysis.
RESULTS: After propensity-matching, there were 235,064 episodes of treatment initiation in each group: approximately 27% had established CV disease. Patient characteristics were well-balanced between groups. Dapagliflozin, empagliflozin, ipragliflozin, canagliflozin, tofogliflozin, and luseogliflozin accounted for 75%, 9%, 8%, 4%, 3%, and 1% of exposure time in the SGLT-2i group, respectively. Use of SGLT-2i versus oGLDs was associated with a lower risk of death (HR: 0.51: 95% confidence interval [CI]: 0.37 to 0.70: p < 0.001), HHF (HR: 0.64: 95% CI: 0.50 to 0.82: p = 0.001), death or HHF (HR: 0.60: 95% CI: 0.47 to 0.76: p < 0.001), MI (HR: 0.81: 95% CI: 0.74 to 0.88: p < 0.001), and stroke (HR: 0.68: 95% CI: 0.55 to 0.84: p < 0.001). Results were directionally consistent across both countries and patient subgroups, including those with and without CV disease.
CONCLUSIONS: In this large, international study of patients with T2D from the Asia Pacific, the Middle East, and North America, initiation of SGLT-2i was associated with a lower risk of CV events across a broad range of outcomes and patient characteristics. (Comparative Effectiveness of Cardiovascular Outcomes in New Users of SGLT-2 Inhibitors [CVD-REAL]: NCT02993614).
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dc.language.isoen-
dc.subject.MESHAdult-
dc.subject.MESHAged-
dc.subject.MESHBlood Glucose-
dc.subject.MESHCardiovascular Diseases-
dc.subject.MESHCohort Studies-
dc.subject.MESHDiabetes Mellitus, Type 2-
dc.subject.MESHElectronic Health Records-
dc.subject.MESHFemale-
dc.subject.MESHHumans-
dc.subject.MESHHypoglycemic Agents-
dc.subject.MESHInternationality-
dc.subject.MESHMale-
dc.subject.MESHMiddle Aged-
dc.subject.MESHSodium-Glucose Transporter 2 Inhibitors-
dc.titleCardiovascular Events Associated With SGLT-2 Inhibitors Versus Other Glucose-Lowering Drugs: The CVD-REAL 2 Study-
dc.typeArticle-
dc.identifier.pmid29540325-
dc.subject.keyworddeath-
dc.subject.keyworddiabetes mellitus-
dc.subject.keywordheart failure-
dc.subject.keywordobservational studies-
dc.subject.keywordsodium glucose cotransporter-2 inhibitors-
dc.subject.keywordSGLT-2 inhibitor-
dc.contributor.affiliatedAuthor김, 대중-
dc.type.localJournal Papers-
dc.identifier.doi10.1016/j.jacc.2018.03.009-
dc.citation.titleJournal of the American College of Cardiology-
dc.citation.volume71-
dc.citation.number23-
dc.citation.date2018-
dc.citation.startPage2628-
dc.citation.endPage2639-
dc.identifier.bibliographicCitationJournal of the American College of Cardiology, 71(23). : 2628-2639, 2018-
dc.embargo.liftdate9999-12-31-
dc.embargo.terms9999-12-31-
dc.identifier.eissn1558-3597-
dc.relation.journalidJ007351097-
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Journal Papers > School of Medicine / Graduate School of Medicine > Endocrinology & Metabolism
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