SGLT2 Inhibitors Linked to Lower Risk of Major Heart Problems in Patients with Type 2 Diabetes


Investigators compared SGLT2 inhibitors with DPP-4 inhibitors to evaluate their effects on the risk of major heart problems.

Heart disease

Results of a recent study published in The BMJ associated sodium glucose cotransporter 2 (SGLT2) inhibitors with a lower risk of major heart problems in patients with type 2 diabetes compared with dipeptidyl peptidase-4 (DPP-4) inhibitors.

Previous studies have evaluated SGLT2 inhibitors and their effect on the risk of heart conditions compared with placebo, and this study builds upon the limitations of earlier trials by employing a real-world clinical practice setting.

The study results stemmed from health care data taken from 7 Canadian provinces, as well as the United Kingdom between 2013 and 2018, in which 209,867 new users of a SGLT2 inhibitor were matched to 209,867 users of a DPP-4 inhibitor. Investigators recorded major cardiovascular events – a combination of heart attack, stroke, or cardiovascular death – as well as heart failure and all-cause mortality for an 11-month average duration.

Investigators reported that, compared with DPP-4 inhibitors, SGLT2 inhibitors were associated with decreased risks of individual events, such as heart attack (5.1 compared with 6.4 events per 1000 person years), cardiovascular death (3.9 compared with 7.7 events per 1000 person years), heart failure (3.1 compared with 7.7 events per 1000 person years) and all-cause mortality (8.7 compared with 17.3 events per 1000 person years).

Results from the observational study were similar across subgroups delineated by age, sex, past insulin use, and history of cardiovascular disease.

Limitations of the study include relying on prescription data over a short follow-up period, and the inability to rule out the possibility of other confounding factors.

Study authors stressed that the findings suggest that SGLT2 inhibitors "offer cardioprotective benefits among people with type 2 diabetes in a real world setting, although additional studies are needed to determine if these benefits persist long term."


  1. Certain diabetes drugs linked to lower risk of major heart problems. News release. BMJ; September 23, 2020. Accessed September 29, 2020.
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