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Cardiovascular outcomes associated with prescription of sodium‐glucose co‐transporter‐2 inhibitors versus dipeptidyl peptidase‐4 inhibitors in patients with diabetes and chronic kidney disease

2022; Wiley; Volume: 24; Issue: 5 Linguagem: Inglês

10.1111/dom.14657

1463-1326

Jinnie J. Rhee, Jialin Han, Maria E. Montez‐Rath, Sun H. Kim, Mark R. Cullen, Randall S. Stafford, Wolfgang C. Winkelmayer­, Glenn M. Chertow,

Gastroesophageal reflux and treatments

Abstract Aim To determine the association with cardiovascular (CV) outcomes of sodium‐glucose co‐transporter‐2 (SGLT‐2) inhibitors compared with dipeptidyl peptidase‐4 (DPP‐4) inhibitors in patients with type 2 diabetes (T2D) and chronic kidney disease (CKD). Materials and Methods We conducted a population‐based cohort study of new users of SGLT‐2 inhibitors and DPP‐4 inhibitors with T2D and CKD using data from Optum Clinformatics DataMart. We assembled three cohorts: T2D/no CKD, T2D/CKD 1‐2, and T2D/CKD 3a. The study outcomes were (a) time to first heart failure (HF) hospitalization and (b) time to a composite CV endpoint comprised of non‐fatal myocardial infarction (MI) or stroke. After inverse probability of treatment weighting, we used proportional hazards regression to estimate hazard ratios (HR) and 95% confidence intervals (CI). Results New users of SGLT‐2 inhibitors versus DPP‐4 inhibitors had lower risks of HF hospitalization in the T2D/no CKD (HR, 0.76; 95% CI, 0.70, 0.82) and T2D/CKD 1‐2 (HR, 0.63; 95% CI, 0.48, 0.84) cohorts, but no significant association was present in the T2D/CKD 3a cohort. Compared with prescription of DPP‐4 inhibitors, SGLT‐2 inhibitors were associated with lower risks of non‐fatal MI or stroke of 23% (HR, 0.77; 95% CI, 0.70, 0.85) in the T2D/no CKD cohort, but no significant associations were present in the T2D/CKD 1‐2 and T2D/CKD 3a cohorts. Conclusions Incident prescription of SGLT‐2 inhibitors was associated with lower risks of HF hospitalization but not with non‐fatal MI or stroke despite suggesting benefit, relative to prescription of DPP‐4 inhibitor across different stages of CKD.