Empagliflozin (EMPA) has demonstrated a greater benefit for those with vs without cardiovascular disease (CVD) in older patients with Type 2 diabetes, according to study results presented at AHA 2021, held from November 13 to 15, 2021.
This study included 2 sets of 1:1 propensity score-matched individuals with type 2 diabetes and CVD: n=31,719 treated with EMPA vs n=31,719 treated with glucagon-like peptide-1 receptor agonists (GLP-1RAs); and n=23,307 treated with EMPA vs n=23,307 treated with dipeptidyl peptidase-4 inhibitors (DPP-4i). All included individuals were at least 65 years of age and initiated their respective treatments. Outcomes included major adverse cardiovascular events (MACEs; included stroke and all-cause death) and hospitalization for heart failure (HHF) while in position for discharge from a primary care facility. Rate differences (RD) per 1000 person-years of follow-up and hazard ratios (HR) were estimated with adjustments for over 140 baseline covariates. Death was treated as a competing risk.
Individuals receiving EMPA showed similar results in terms of MACE risk. (HR 1.05; 95% CI, 0.93-1.18) to that receiving and GLP-1RA, but EMPA was associated with a lower risk for HHF (HR 0.70; 95% CI, 0.57-0.86). Individuals with CVD experienced a larger absolute benefit compared with those without CVD (RD -6.24 [95% CI, -9.92 to -2.56] vs -0.81 [95% CI, -2.15 to 0.54], respectively). EMPA was also associated with a lower risk for both MACE (HR 0.67; 95% CI, 0.59-0.77) and HHF (HR 0.46; 95% CI, 0.37-0.57) when compared with DPP-4i.
The study authors concluded that “for both outcomes, the absolute benefit with EMPA was larger among patients with CVD compared to those without CVD.” More specifically, “EMPA reduced the risk of HHF vs. GLP-1RA and DPP-4i and the risk of a modified MACE outcome vs. DPP-4i.” Compared with those without CVD, researchers indicated that the “absolute benefit associated with EMPA was larger among patients with CVD.”
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Htoo P, Paik J, Tesfaye H, et al. Cardiovascular effectiveness of empagliflozin compared to glucagon like peptide-1 receptor agonists and to dipeptidyl peptidase-4 inhibitors in older patients: results from the empagliflozin comparative effectiveness and safety (EMPRISE) study. Presented at: AHA 2021; November 13-15, 2021. Poster: P1063.