SGLT2 Inhibitors and Prevention of Cardiovascular Events in Diabetes Patients with and Without Hypertension

Objective: The primary prevention of major adverse cardiovascular events by sodium-glucose cotransporter-2 inhibitors (SGLT2i) in patients with type 2 diabetes without cardiovascular disease (CVD) remains unclear. Research Design and Methods: We used propensity score matching to identify 9520 pairs of SGLT2i users compared with DPP-4 inhibitor users in patients with hypertension and 3496 pairs in patients without hypertension using data from Taiwan’s National Health Insurance Research Database for the period between January 1, 2008, and December 31, 2021. Cox proportional hazards models were used to assess the risk of outcomes between SGLT2i and DPP-4 inhibitor users. Results: Mean follow-up was 2.81 years for the cohort of patients with hypertension and 2.79 years for those without hypertension. Compared to the use of DPP-4 inhibitors, the use of SGLT2i was significantly associated with a reduced risk of developing stroke [aHR (95% CI) 0.56(0.47–0.66)], coronary artery disease [0.80(0.69–0.94)], heart failure [0.31(0.24–0.41)], and major adverse cardiovascular events (MACE) [0.62(0.56–0.70)] in patients with hypertension. Additionally, in patients without hypertension, SGLT2i use was significantly associated with a reduced risk of developing atrial fibrillation [aHR (95% CI) 0.48(0.25–0.91)]. Conclusions: This nationwide cohort study demonstrates that in T2D patients without cardiovascular disease, SGLT2i use is associated with a lower risk of coronary heart disease, stroke, heart failure, and MACE in those with hypertension. In patients without hypertension, SGLT2i use was linked to a reduced risk of atrial fibrillation, suggesting its potential role in the primary prevention of cardiovascular events for T2D patients.