1086-P: Cardiovascular Effectiveness of SGLT2 Inhibitors: Head-to-Head Comparisons

In placebo-controlled cardiovascular (CV) outcome trials, SGLT2 inhibitors (SGLT2i) reduced the risk of CV events in patients with T2D and CV disease. However, not all trials showed consistent CV benefits across individual SGLT2i. We assembled a cohort of adults with T2D (median age 62, 57% male) , newly treated with an SGLT2i (canagliflozin, dapagliflozin, empagliflozin) from Medicare and two US commercial healthcare claims databases (4/2012 - 12/2020) . We assessed the risk of a composite event of myocardial infarction (MI) or stroke (MI/stroke) , its individual components, hospitalization for heart failure (HHF) , and mortality. To account for differences between initiators of different SGLT2i, we reweighed each group using inverse probability of treatment weights, adjusting for >130 baseline characteristics. In each database, hazard ratios (HRs) and 95% CI were estimated using Cox proportional hazards models and results were pooled using random-effects models. Compared to canagliflozin, the most frequently used SGLT2i during the study period, dapagliflozin and empagliflozin had a similar risk of MI/stroke, though empagliflozin was associated with a reduced risk of HHF [HR (95% CI) = 0.73 (0.57-0.94) ], over a median 0.65 years of follow-up. Individual SGLT2i showed a similar risk of other outcomes (Table) . This study suggests that SGLT2i have similar effectiveness on most CV outcomes and mortality in patients with T2D.

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