Sodium‐Glucose Cotransporter 2 Inhibitors, All‐Cause Mortality, and Cardiovascular Outcomes in Adults with Type 2 Diabetes: A Bayesian Meta‐Analysis and Meta‐Regression
Background This study aimed to assess the effectiveness of sodium‐glucose cotransporter 2 inhibitors in reducing the incidence of mortality and cardiovascular outcomes in adults with type 2 diabetes. Methods and Results We conducted a Bayesian meta‐analysis of randomized controlled trials comparing...
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2021
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oai:doaj.org-article:5a15a9b65191411ea43cd3eccab5183b2021-11-23T11:36:35ZSodium‐Glucose Cotransporter 2 Inhibitors, All‐Cause Mortality, and Cardiovascular Outcomes in Adults with Type 2 Diabetes: A Bayesian Meta‐Analysis and Meta‐Regression10.1161/JAHA.120.0199182047-9980https://doaj.org/article/5a15a9b65191411ea43cd3eccab5183b2021-09-01T00:00:00Zhttps://www.ahajournals.org/doi/10.1161/JAHA.120.019918https://doaj.org/toc/2047-9980Background This study aimed to assess the effectiveness of sodium‐glucose cotransporter 2 inhibitors in reducing the incidence of mortality and cardiovascular outcomes in adults with type 2 diabetes. Methods and Results We conducted a Bayesian meta‐analysis of randomized controlled trials comparing sodium‐glucose cotransporter 2 inhibitors with placebo. We used meta‐regression to examine the association between treatment effects and control group event rates as measures of cardiovascular baseline risk. Fifty‐three randomized controlled trials were included in our synthesis. Empagliflozin, canagliflozin, and dapagliflozin reduced the incidence of all‐cause mortality (empagliflozin: rate ratio [RR], 0.79; 95% credibility interval [CrI], 0.63–0.97; canagliflozin: RR, 0.86; 95% CrI, 0.69–1.05; dapagliflozin: RR, 0.86; 95% CrI, 0.72–1.01) and cardiovascular mortality (empagliflozin: RR, 0.78; 95% CrI, 0.61–1.00; canagliflozin: RR, 0.83; 95% CrI, 0.63–1.05; dapagliflozin: RR, 0.88; 95% CrI, 0.71–1.08), with a 90.1% to 98.7% probability for the true RR to be <1.00 for both outcomes. There was little evidence for ertugliflozin and sotagliflozin versus placebo for reducing all‐cause and cardiovascular mortality. There was no association between treatment effects for all‐cause and cardiovascular mortality and the control group event rates. There was evidence for a reduction in the incidence of heart failure for empagliflozin, canagliflozin, dapagliflozin, and ertugliflozin versus placebo (probability RR <1.00 of ≥99.3%) and weaker, albeit positive, evidence for acute myocardial infarction for the first 3 agents (probability RR <1.00 of 89.0%–95.2%). There was little evidence of any agent except canagliflozin for reducing the incidence of stroke. Conclusions Empagliflozin, canagliflozin, and dapagliflozin reduced the incidence of all‐cause and cardiovascular mortality versus placebo. Treatment effects of sodium‐glucose cotransporter 2 inhibitors versus placebo do not vary by baseline risk.Ayodele OdutayoBruno R. da CostaTiago V. PereiraVinay GargSamir IskanderFatimah RobleRahim LaljiCesar A. HincapiéAquila AkingbadeMyanca RodriguesArnav AgarwalBishoy LawendyPakeezah SaadatJacob A. UdellFrancesco CosentinoPeter J. GrantSubodh VermaPeter JüniWileyarticleheart failureischemic strokemeta‐analysismyocardial infarctiontype 2 diabetesDiseases of the circulatory (Cardiovascular) systemRC666-701ENJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, Vol 10, Iss 18 (2021) |
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heart failure ischemic stroke meta‐analysis myocardial infarction type 2 diabetes Diseases of the circulatory (Cardiovascular) system RC666-701 |
| spellingShingle |
heart failure ischemic stroke meta‐analysis myocardial infarction type 2 diabetes Diseases of the circulatory (Cardiovascular) system RC666-701 Ayodele Odutayo Bruno R. da Costa Tiago V. Pereira Vinay Garg Samir Iskander Fatimah Roble Rahim Lalji Cesar A. Hincapié Aquila Akingbade Myanca Rodrigues Arnav Agarwal Bishoy Lawendy Pakeezah Saadat Jacob A. Udell Francesco Cosentino Peter J. Grant Subodh Verma Peter Jüni Sodium‐Glucose Cotransporter 2 Inhibitors, All‐Cause Mortality, and Cardiovascular Outcomes in Adults with Type 2 Diabetes: A Bayesian Meta‐Analysis and Meta‐Regression |
| description |
Background This study aimed to assess the effectiveness of sodium‐glucose cotransporter 2 inhibitors in reducing the incidence of mortality and cardiovascular outcomes in adults with type 2 diabetes. Methods and Results We conducted a Bayesian meta‐analysis of randomized controlled trials comparing sodium‐glucose cotransporter 2 inhibitors with placebo. We used meta‐regression to examine the association between treatment effects and control group event rates as measures of cardiovascular baseline risk. Fifty‐three randomized controlled trials were included in our synthesis. Empagliflozin, canagliflozin, and dapagliflozin reduced the incidence of all‐cause mortality (empagliflozin: rate ratio [RR], 0.79; 95% credibility interval [CrI], 0.63–0.97; canagliflozin: RR, 0.86; 95% CrI, 0.69–1.05; dapagliflozin: RR, 0.86; 95% CrI, 0.72–1.01) and cardiovascular mortality (empagliflozin: RR, 0.78; 95% CrI, 0.61–1.00; canagliflozin: RR, 0.83; 95% CrI, 0.63–1.05; dapagliflozin: RR, 0.88; 95% CrI, 0.71–1.08), with a 90.1% to 98.7% probability for the true RR to be <1.00 for both outcomes. There was little evidence for ertugliflozin and sotagliflozin versus placebo for reducing all‐cause and cardiovascular mortality. There was no association between treatment effects for all‐cause and cardiovascular mortality and the control group event rates. There was evidence for a reduction in the incidence of heart failure for empagliflozin, canagliflozin, dapagliflozin, and ertugliflozin versus placebo (probability RR <1.00 of ≥99.3%) and weaker, albeit positive, evidence for acute myocardial infarction for the first 3 agents (probability RR <1.00 of 89.0%–95.2%). There was little evidence of any agent except canagliflozin for reducing the incidence of stroke. Conclusions Empagliflozin, canagliflozin, and dapagliflozin reduced the incidence of all‐cause and cardiovascular mortality versus placebo. Treatment effects of sodium‐glucose cotransporter 2 inhibitors versus placebo do not vary by baseline risk. |
| format |
article |
| author |
Ayodele Odutayo Bruno R. da Costa Tiago V. Pereira Vinay Garg Samir Iskander Fatimah Roble Rahim Lalji Cesar A. Hincapié Aquila Akingbade Myanca Rodrigues Arnav Agarwal Bishoy Lawendy Pakeezah Saadat Jacob A. Udell Francesco Cosentino Peter J. Grant Subodh Verma Peter Jüni |
| author_facet |
Ayodele Odutayo Bruno R. da Costa Tiago V. Pereira Vinay Garg Samir Iskander Fatimah Roble Rahim Lalji Cesar A. Hincapié Aquila Akingbade Myanca Rodrigues Arnav Agarwal Bishoy Lawendy Pakeezah Saadat Jacob A. Udell Francesco Cosentino Peter J. Grant Subodh Verma Peter Jüni |
| author_sort |
Ayodele Odutayo |
| title |
Sodium‐Glucose Cotransporter 2 Inhibitors, All‐Cause Mortality, and Cardiovascular Outcomes in Adults with Type 2 Diabetes: A Bayesian Meta‐Analysis and Meta‐Regression |
| title_short |
Sodium‐Glucose Cotransporter 2 Inhibitors, All‐Cause Mortality, and Cardiovascular Outcomes in Adults with Type 2 Diabetes: A Bayesian Meta‐Analysis and Meta‐Regression |
| title_full |
Sodium‐Glucose Cotransporter 2 Inhibitors, All‐Cause Mortality, and Cardiovascular Outcomes in Adults with Type 2 Diabetes: A Bayesian Meta‐Analysis and Meta‐Regression |
| title_fullStr |
Sodium‐Glucose Cotransporter 2 Inhibitors, All‐Cause Mortality, and Cardiovascular Outcomes in Adults with Type 2 Diabetes: A Bayesian Meta‐Analysis and Meta‐Regression |
| title_full_unstemmed |
Sodium‐Glucose Cotransporter 2 Inhibitors, All‐Cause Mortality, and Cardiovascular Outcomes in Adults with Type 2 Diabetes: A Bayesian Meta‐Analysis and Meta‐Regression |
| title_sort |
sodium‐glucose cotransporter 2 inhibitors, all‐cause mortality, and cardiovascular outcomes in adults with type 2 diabetes: a bayesian meta‐analysis and meta‐regression |
| publisher |
Wiley |
| publishDate |
2021 |
| url |
https://doaj.org/article/5a15a9b65191411ea43cd3eccab5183b |
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