Br J Clin Pharmacol. 2025 Dec 14. doi: 10.1002/bcp.70416. Online ahead of print.
ABSTRACT
AIMS: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have well-documented cardiovascular benefits. However, the cardiovascular benefits of early SGLT2i use in diabetics experiencing acute myocardial infarction (MI) remain unclear.
METHODS: To evaluate the cardiovascular effects of early initiation of SGLT2i in diabetics experiencing acute MI, this study emulated a target trial using data from Taiwan's Health Research Data Integration Service of the National Health Insurance Administration. This study analysed cardiovascular composite outcomes, including hospitalization for heart failure (HHF), MI re-hospitalization, ischaemic stroke, cardiovascular mortality, and individual outcomes. Adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using Cox proportional hazard models.
RESULTS: Among 36,103 diabetic patients experiencing acute MI, SGLT2i administration within 14 days after acute MI (N = 2,149) reduced cardiovascular composite risks relative to dipeptidyl peptidase-4 inhibitors (DPP4i) (N = 10,802, HR = 0.89, 95% CI: 0.82-0.96, p = 0.0017). Compared to DPP4i, SGLT2i significantly reduced HHF (HR = 0.86, 0.79-0.95), MI re-hospitalization (HR = 0.70, 0.62-0.80), and cardiovascular mortality (HR = 0.65, 0.54-0.79) risks, but not ischaemic stroke. Sensitivity analysis confirmed the robust therapeutic efficacy of SGLT2i, and Subgroup analyses suggested that the therapeutic efficacy of SGLT2i may be affected by chronic kidney disease, age, and percutaneous coronary intervention. The cardiovascular benefits were consistent across patients without heart failure and new SGLT2i users. Exploratory analyses revealed comparable results between SGLT2i and glucagon-like peptide-1 receptor agonists.
CONCLUSIONS: Early SGLT2i use in diabetics experiencing acute MI reduced cardiovascular risk, supporting its potential therapeutic use.
PMID:41392024 | DOI:10.1002/bcp.70416