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Incident heart failure and myocardial infarction in sodium‐glucose cotransporter‐2 vs. dipeptidyl peptidase‐4 inhibitor users

Zhou, Jiandong, Lee, Sharen, Leung, Keith Sai Kit, Wai, Abraham Ka Chung, Liu, Tong, Liu, Ying, Chang, Dong, Wong, Wing Tak, Wong, Ian Chi Kei, Cheung, Bernard Man Yung, and others. (2022) Incident heart failure and myocardial infarction in sodium‐glucose cotransporter‐2 vs. dipeptidyl peptidase‐4 inhibitor users. ESC Heart Failure, 9 (2). pp. 1388-1399. ISSN 2055-5822. (doi:10.1002/ehf2.13830) (KAR id:93776)


Aims This study aimed to compare the rates of major cardiovascular adverse events in sodium-glucose cotransporter-2 inhibitors (SGLT2I) and dipeptidyl peptidase-4 inhibitors (DPP4I) users in a Chinese population. SGLT2I and DPP4I are increasingly prescribed for type 2 diabetes mellitus patients. However, few population-based studies are comparing their effects on incident heart failure or myocardial infarction.

Methods and results This was a population-based retrospective cohort study using the electronic health record database in Hong Kong, including type 2 diabetes mellitus patients receiving either SGLT2I or DPP4I from 1 January 2015 to 31 December 2020. Propensity score matching was performed in a 1:1 ratio based on demographics, past comorbidities, and non-SGLT2I/ DPP4I medications with nearest neighbour matching (caliper = 0.1). Univariable and multivariable Cox models were used to identify significant predictors for new-onset heart failure, new-onset myocardial infarction, cardiovascular mortality, and all-cause mortality. Sensitivity analyses with competing risk models and multiple propensity score matching approaches were conducted. A total of 41 994 patients (58.89% males, median admission age at 58 years old, interquartile range [IQR]: 51.2–65.3) were included with a median follow-up of 5.6 years (IQR: 5.32–5.82). In the matched cohort, SGLT2I use was significantly associated with lower risks of new-onset heart failure (hazard ratio [HR]: 0.73, 95% confidence interval [CI]: [0.66,

0.81], P < 0.0001), myocardial infarction (HR: 0.81, 95% CI: [0.73, 0.90], P < 0.0001), cardiovascular mortality (HR: 0.67, 95% CI: [0.53, 0.84], P < 0.001), and all-cause mortality (HR: 0.26, 95% CI: [0.24, 0.29], P < 0.0001) after adjusting for significant demographics, past comorbidities, and non-SGLT2I/DPP4I medications.

Conclusions SGLT2 inhibitors are protective against adverse cardiovascular events including new-onset heart failure, myocardial infarction, cardiovascular mortality, and all-cause mortality. The prescription of SGLT2I is preferred when taken into consideration individual cardiovascular and metabolic risk profiles in addition to drug–drug interactions

Item Type: Article
DOI/Identification number: 10.1002/ehf2.13830
Additional information: ** Article version: VoR ** From Crossref journal articles via Jisc Publications Router ** History: epub 07-02-2022; issued 07-02-2022. ** Licence for VoR version of this article starting on 07-02-2022:
Uncontrolled keywords: Sodium-glucose co-transporter; Heart failure; Myocardial infarction; Diabetes mellitus
Subjects: R Medicine
Divisions: Divisions > Division of Natural Sciences > Kent and Medway Medical School
Funders: University of Kent (
SWORD Depositor: JISC Publications Router
Depositing User: JISC Publications Router
Date Deposited: 09 Aug 2022 15:32 UTC
Last Modified: 09 Aug 2022 15:32 UTC
Resource URI: (The current URI for this page, for reference purposes)

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