TY - JOUR
T1 - Empagliflozin is associated with lower cardiovascular risk compared with dipeptidyl peptidase-4 inhibitors in adults with and without cardiovascular disease
T2 - EMPagliflozin compaRative effectIveness and SafEty (EMPRISE) study results from Europe and Asia
AU - Vistisen, Dorte
AU - Carstensen, Bendix
AU - Elisabetta, Patorno
AU - Lanzinger, Stefanie
AU - Tan, Elise Chia Hui
AU - Yabe, Daisuke
AU - Kim, Dae Jung
AU - Sheu, Wayne H.H.
AU - Melzer-Cohen, Cheli
AU - Holl, Reinhard W.
AU - Núñez, Júlio
AU - Ha, Kyoung Hwa
AU - Halvorsen, Sigrun
AU - Langslet, Gisle
AU - Karasik, Avraham
AU - Nyström, Thomas
AU - Niskanen, Leo
AU - Guleria, Sonia
AU - Klement, Riho
AU - Carrasco, Marc
AU - Foersch, Johannes
AU - Shay, Christina
AU - Koeneman, Lisette
AU - Hoti, Fabian
AU - Farsani, Soulmaz Fazeli
AU - Khunti, Kamlesh
AU - Zaccardi, Francesco
AU - Subramanian, Anuradhaa
AU - Nirantharakumar, Krishnarajah
N1 - Publisher Copyright:
© 2023, BioMed Central Ltd., part of Springer Nature.
PY - 2023/12
Y1 - 2023/12
N2 - Background: Studies that have reported lower risk for cardiovascular outcomes in users of Sodium–Glucose Cotransporter-2 Inhibitors (SGLT-2i) are limited by residual cofounding and lack of information on prior cardiovascular disease (CVD). This study compared risk of cardiovascular events in patients within routine care settings in Europe and Asia with type 2 diabetes (T2D) initiating empagliflozin compared to dipeptidyl peptidase-4 inhibitors (DPP-4i) stratified by pre-existing CVD and history of heart failure (HF). Methods and results: Adults initiating empagliflozin and DPP-4i in 2014–2018/19 from 11 countries in Europe and Asia were compared using propensity score matching and Cox proportional hazards regression to assess differences in rates of primary outcomes: hospitalisation for heart failure (HHF), myocardial infarction (MI), stroke; and secondary outcomes: cardiovascular mortality (CVM), coronary revascularisation procedure, composite outcome including HHF or CVM, and 3-point major adverse cardiovascular events (MACE: MI, stroke and CVM). Country-specific results were meta-analysed and pooled hazard ratios (HR) with 95% confidence intervals (CI) from random-effects models are presented. In total, 85,244 empagliflozin/DPP4i PS-matched patient pairs were included with overall mean follow-up of 0.7 years. Among those with pre-existing CVD, lower risk was observed for HHF (HR 0.74; 95% CI 0.64–0.86), CVM (HR 0.55; 95% CI 0.38–0.80), HHF or CVM (HR 0.57; 95% CI 0.48–0.67) and stroke (HR 0.79; 95% CI 0.67–0.94) in patients initiating empagliflozin vs DPP-4i. Similar patterns were observed among patients without pre-existing CVD and those with and without pre-existing HF. Conclusion: These results from diverse patient populations in routine care settings across Europe and Asia demonstrate that initiation of empagliflozin compared to DPP-4i results in favourable cardioprotective effects regardless of pre-existing CVD or HF status.
AB - Background: Studies that have reported lower risk for cardiovascular outcomes in users of Sodium–Glucose Cotransporter-2 Inhibitors (SGLT-2i) are limited by residual cofounding and lack of information on prior cardiovascular disease (CVD). This study compared risk of cardiovascular events in patients within routine care settings in Europe and Asia with type 2 diabetes (T2D) initiating empagliflozin compared to dipeptidyl peptidase-4 inhibitors (DPP-4i) stratified by pre-existing CVD and history of heart failure (HF). Methods and results: Adults initiating empagliflozin and DPP-4i in 2014–2018/19 from 11 countries in Europe and Asia were compared using propensity score matching and Cox proportional hazards regression to assess differences in rates of primary outcomes: hospitalisation for heart failure (HHF), myocardial infarction (MI), stroke; and secondary outcomes: cardiovascular mortality (CVM), coronary revascularisation procedure, composite outcome including HHF or CVM, and 3-point major adverse cardiovascular events (MACE: MI, stroke and CVM). Country-specific results were meta-analysed and pooled hazard ratios (HR) with 95% confidence intervals (CI) from random-effects models are presented. In total, 85,244 empagliflozin/DPP4i PS-matched patient pairs were included with overall mean follow-up of 0.7 years. Among those with pre-existing CVD, lower risk was observed for HHF (HR 0.74; 95% CI 0.64–0.86), CVM (HR 0.55; 95% CI 0.38–0.80), HHF or CVM (HR 0.57; 95% CI 0.48–0.67) and stroke (HR 0.79; 95% CI 0.67–0.94) in patients initiating empagliflozin vs DPP-4i. Similar patterns were observed among patients without pre-existing CVD and those with and without pre-existing HF. Conclusion: These results from diverse patient populations in routine care settings across Europe and Asia demonstrate that initiation of empagliflozin compared to DPP-4i results in favourable cardioprotective effects regardless of pre-existing CVD or HF status.
KW - Cardiovascular disease
KW - Comparative effectiveness
KW - Dipeptidyl peptidase-4 inhibitors
KW - Empagliflozin
KW - Heart failure
KW - Type 2 diabetes
UR - http://www.scopus.com/inward/record.url?scp=85169356211&partnerID=8YFLogxK
U2 - 10.1186/s12933-023-01963-9
DO - 10.1186/s12933-023-01963-9
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C2 - 37653496
AN - SCOPUS:85169356211
SN - 1475-2840
VL - 22
JO - Cardiovascular Diabetology
JF - Cardiovascular Diabetology
IS - 1
M1 - 233
ER -