Background: Influential guidelines recommend using SGLT2i preferentially among antidiabetic drugs in patients with diabetes and ASCVD. Although CVOTs with SGLT2i showed reduction in risk of 3-point major adverse cardiovascular events (MACE), they did not demonstrate beneficial effect on stroke. In addition, a meta-analysis reported adverse effect of SGLT2i for stroke. On the contrary, pioglitazone, a type of TZD, demonstrated the effect in secondary stroke prevention from two large RCTs. The aim of this study was to compare the effect of SGLT2i and TZD on the risk of stroke among patients with type 2 diabetes.

Methods: Using the Korean National Health Insurance Service data, we compared a 1:1 propensity score-matched cohort of patients who were new users of SGLT2i (n = 82,044) and TZD (n = 82,044) from January 2014 to December 2018. The primary outcome was stroke. The secondary outcomes were MI, CV death, and 3-point MACE.

Results: The incidence rates of stroke were 5.2 and 5.3 per 1000 person-years in SGLT2i-treated patients and TZD-treated patients, respectively. The hazard ratio of stroke was 0.955 (95% CI: 0.841-1.084) in SGLT2i-treated patients compared with TZD-treated patients. There was no clear difference in risk of MI (HR: 1.151, 95% CI: 0.914-1.449), CV death (HR: 0.865, 95% CI: 0.660-1.132), 3-point mace (HR: 0.988, 95% CI: 0.894-1.092) between two groups. Results were consistent regardless of prior CV disease.

Conclusions: In this real-world data, the risk of stroke was comparable in patients with type 2 diabetes treated with TZD vs. SGLT2i.


S. Lee: None. H. Nam: None. H. Choi: None. K. Kim: None.

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