Empagliflozin is associated with lower cardiovascular risk compared with dipeptidyl peptidase-4 inhibitors in adults with and without cardiovascular disease: EMPagliflozin compaRative effectIveness and SafEty (EMPRISE) study results from Europe and Asia
Dorte Vistisen, Bendix Carstensen, Patorno E Elisabetta, Stefanie Lanzinger, Elise Tan, Daisuke Yabe, Dae Jung Kim, Wayne Huey‐Herng Sheu, Cheli Melzer Cohen, Reinhard W. Holl, Julio Núñez, Kyoung Hwa Ha, Sigrun Halvorsen, Gisle Langslet, Avraham Karasik, Thomas Nyström, Leo Niskanen, Sonia Guleria, Riho Klement, Marc Carrasco, Johannes Foersch, Christina M. Shay, Lisette Koeneman, Fabian Hoti, Soulmaz Fazeli Farsani, Kamlesh Khunti, Francesco Zaccardi, Anuradhaa Subramanian, Krishnarajah Nirantharakumar, EMPRISE EU, Kimberly G. Brodovicz, Kristina Zint, J. Försch, Doron Rosenzweig, Maria Lajer, Mikkel Overgaard, Emilie Toresson Grip, Emma Söreskog, Joel Gunnarsson, Kristina Karlsdotter, Lotta K. Stenman, Mikko Tuovinen, Neus Valveny, Paula Casajust, Ruth Farmer, Andrew Ternouth, Anne Pernille Ofstad, East Asia Study Group, Masaomi Nangaku, Koichi Node, Yusuke Taneda, Atsutaka Yasui, Yutaka Seino, Jingbo Yi, Wei‐Yu Lei, Sunwoo Lee, Jinhee Lee
Abstract
BACKGROUND: Studies that have reported lower risk for cardiovascular outcomes in users of Sodium-Glucose Cotransporter-2 Inhibitors (SGLT-2i) are limited by residual cofounding and lack of information on prior cardiovascular disease (CVD). This study compared risk of cardiovascular events in patients within routine care settings in Europe and Asia with type 2 diabetes (T2D) initiating empagliflozin compared to dipeptidyl peptidase-4 inhibitors (DPP-4i) stratified by pre-existing CVD and history of heart failure (HF). METHODS AND RESULTS: Adults initiating empagliflozin and DPP-4i in 2014-2018/19 from 11 countries in Europe and Asia were compared using propensity score matching and Cox proportional hazards regression to assess differences in rates of primary outcomes: hospitalisation for heart failure (HHF), myocardial infarction (MI), stroke; and secondary outcomes: cardiovascular mortality (CVM), coronary revascularisation procedure, composite outcome including HHF or CVM, and 3-point major adverse cardiovascular events (MACE: MI, stroke and CVM). Country-specific results were meta-analysed and pooled hazard ratios (HR) with 95% confidence intervals (CI) from random-effects models are presented. In total, 85,244 empagliflozin/DPP4i PS-matched patient pairs were included with overall mean follow-up of 0.7 years. Among those with pre-existing CVD, lower risk was observed for HHF (HR 0.74; 95% CI 0.64-0.86), CVM (HR 0.55; 95% CI 0.38-0.80), HHF or CVM (HR 0.57; 95% CI 0.48-0.67) and stroke (HR 0.79; 95% CI 0.67-0.94) in patients initiating empagliflozin vs DPP-4i. Similar patterns were observed among patients without pre-existing CVD and those with and without pre-existing HF. CONCLUSION: These results from diverse patient populations in routine care settings across Europe and Asia demonstrate that initiation of empagliflozin compared to DPP-4i results in favourable cardioprotective effects regardless of pre-existing CVD or HF status.