After the unexpected cardiovascular (CV) benefit observed in the EMPA-REG OUTCOME study of the SGLT-2 inhibitor, empagliflozin, there has been a surge of research trying to decipher whether this new class of type 2 diabetes (T2D) drugs has a CV protective role. Towards this, results from the first large-scale real world evidence study of SGLT-2 inhibitors, CVD-REAL, were presented at the American College of Cardiology’s Featured Clinical Research session. Data from the study, sponsored by AstraZeneca, confirmed the CV benefit observed with this drug class, and interestingly it was suggested that SGLT-2 inhibitors may have potential to prevent heart failure (HF).

It is well established that T2D patients have an increased risk of developing CV disease, particularly HF. So to follow on from EMPA-REG OUTCOME, CVD-REAL aimed to determine if the benefit is due to a class effect, and also to see if the effects observed in patients with established CV disease apply to T2D patients with a broader CV risk profile. To assess this, researchers compared hospitalisations for HF as well as all-cause death in patients receiving an SGLT-2 inhibitor versus those on other glucose-lowering drugs (oGLDs).
In patients receiving an SGLT2-inhibitor, either empagliflozin, dapagliflozin or canagliflozin, a significant reduction of 39% in rate of HF hospitalizations was observed compared to oGLD treatment. A 51% reduction in all-cause death was also seen, and the composite endpoint of hospitalization for HF or all-cause death was reduced by 46% in the SGLT2 inhibitor group.

The results for CVD-REAL were extremely impressive, particularly as 87% of patients enrolled did not have a history of CV disease or HF at baseline, suggesting that the benefits of SGLT-2 inhibitors may extend to low CV risk T2D patients. Moreover the results were consistent with all three SGLT-2 inhibitors, implying that this is a class effect and not compound specific.

T2D is growing in prevalence, and since it is a serious risk factor for developing CV disease complications, preventing CV disease has become an important unmet need in these patients. The data from CVD-REAL not only show the beneficial effects of SGLT-2 inhibitors on CV outcomes, but they confirm this in a real world clinical population. Moreover these results suggest that HF prevention is becoming a possibility for diabetic patients.