Treatment with a sodium glucose cotransporter–2 inhibitor (SGLT–2i) was associated with a marked reduction in hospitalization for heart failure (HHF) when compared with treatment with other glucose–lowering drugs (oGLD), according to research presented by Mikhail Kosiborod, MD, FACC, on March 19 at ACC.17.

In a large, real–world study across six countries, non–parsimonious propensity scores for SGLT–2i initiation were used to match groups in which a broad population of patients with type 2 diabetes received either SGLT–2i or oGLD treatment. The incidence of HHF was collected via primary care and hospital records in the U.K. and Germany, medical claims and electronic health records in the U.S., and national registries in Sweden, Norway and Denmark. Hazard ratios for HHF were estimated by country and database and pooled in a meta–analysis.

The study included 364,828 patients, evenly divided between each treatment group, with a mean age of 57 years and 44 percent were women. At baseline, 3 percent had HF, 13 percent established cardiovascular disease, and 27 percent had microvascular disease.

For the primary endpoint of HHF, there was a reduction that favored the SGLT–2i in each country. In total, there were 961 HHF during the study period, and the incidence was lower with the SGLT–2i (hazard ratio [HR], 0.61; p < 0.001). The SGLT–2i was also associated with a lower incidence of the secondary endpoint of all–cause death in each country and the total number was 1,334 (HR, 0.49; p < 0.001) and the secondary endpoint of HHF or all–cause death (1,983 events; HR, 0.54; p < 0.001).

In the analysis, there were no signs of significant heterogeneity across the countries, despite the geographic variations in the patient groups receiving SGLT–2i treatment, suggesting the cardiovascular benefits observed are likely class–related, according to the investigators. The results of their analyses align with the findings of the EMPA–REG OUTCOME study, and they think the benefits observed with the SGLT–2i treatment will translate into real–world clinical practice and may also extend to patients with type 2 diabetes at the lower end of the cardiovascular risk spectrum.