The SGLT2 inhibitor dapagliflozin reduced heart failure hospitalization (HFH) and cardiovascular mortality in patients with type 2 diabetes (T2D) and HF across a wide spectrum of left ventricular ejection fraction (LVEF). The greatest benefit was found in those with HF with reduced ejection fraction (HFrEF). The findings were presented on March 18 at ACC.19 in New Orleans, LA, and simultaneously published in Circulation.
In this international study with more than 17,000 patients with T2D, as well as either established cardiovascular disease or a high risk for cardiovascular disease, randomization was to either dapagliflozin 10 mg or placebo. Median follow-up was four years.
At baseline, 30 percent of participants (5,202) had their LVEF documented. Of these, 13 percent (671 patients) had HFrEF.
Eri T. Kato, MD, PhD, et al., reported that dapagliflozin decreased HFH across all patients, regardless of ejection fraction or whether or not they had HF at baseline. In patients with HFrEF, there was a significant 38 percent reduction in death or HFH with dapagliflozin vs. placebo. In patients without HFrEF, the reduction in the primary endpoint was 12 percent with dapagliflozin vs. placebo.
Additionally, in patients with HFrEF there as a 45 percent reduction in cardiovascular death and 41 percent reduction in all-cause mortality with dapagliflozin vs. placebo. This reduction was not seen in patients without HFrEF.
“The clinical implication of this finding is that ejection fraction is a strong tool to identify those who are at highest risk and may derive particular benefit from SGLT2 inhibitors,” said Kato.
The authors are conducing additional research on the DECLARE-TIMI 58 data to assess dapagliflozin’s effects on metabolic, renal and cardiovascular outcomes. Other ongoing trials are investigating the use of SGLT2 inhibitors in HF patients.
Keywords: Diabetes Mellitus, Type 2, Stroke Volume, Heart Failure, Benzhydryl Compounds, Primary Prevention, Metabolic Syndrome X, ACC19, ACC Annual Scientific Session, ACC19, ACC Annual Scientific Session