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SGLT2 inhibitors for patients with type 2 diabetes mellitus after myocardial infarction : a nationwide observation registry study from SWEDEHEART

Rosén, Hans Christian LU orcid ; Mohammad, Moman A. LU orcid ; Jernberg, Tomas ; James, Stefan ; Oldgren, Jonas and Erlinge, David LU orcid (2024) In The Lancet Regional Health - Europe 45.
Abstract

Background: Sodium-glucose co-transporter 2 (SGLT2) inhibitors have been shown to reduce rates of heart failure hospitalisations and cardiovascular death in patients with type 2 diabetes and prior cardiovascular disease. We hypothesised that SGLT2 inhibitors could provide cardiovascular benefits in the post-myocardial infarction setting. We aimed to investigate cardiovascular outcomes of SGLT2 inhibitor therapy in patients with type 2 diabetes mellitus after myocardial infarction in a Swedish nationwide registry. Methods: We included all patients with type 2 diabetes surviving a type 1 acute myocardial infarction from January 1, 2018 to December 31, 2021. Patients were included if they were discharged with an estimated glomerular... (More)

Background: Sodium-glucose co-transporter 2 (SGLT2) inhibitors have been shown to reduce rates of heart failure hospitalisations and cardiovascular death in patients with type 2 diabetes and prior cardiovascular disease. We hypothesised that SGLT2 inhibitors could provide cardiovascular benefits in the post-myocardial infarction setting. We aimed to investigate cardiovascular outcomes of SGLT2 inhibitor therapy in patients with type 2 diabetes mellitus after myocardial infarction in a Swedish nationwide registry. Methods: We included all patients with type 2 diabetes surviving a type 1 acute myocardial infarction from January 1, 2018 to December 31, 2021. Patients were included if they were discharged with an estimated glomerular filtration rate (eGFR) > 30 mL/min/1.73 m2 in the nationwide Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies (SWEDEHEART) registry. We identified all patients discharged with or without an SGLT2 inhibitor prescription 120 days before or within three days after discharge from the cardiac care unit. The primary outcome measure was a composite of death and first hospitalisation for heart failure after one year analysed using an adjusted Cox regression. Findings: A total of 11,271 patients were included. Of these, 2498 (22.2%) received SGLT2 inhibitor treatment. Patients who were prescribed SGLT2 inhibitors were younger, more often presented with a STEMI and had worse left ventricular ejection fraction at index hospitalisation. SGLT2 inhibitor use was associated with lower rates of the composite outcome (hazard ratio (HR) of 0.70 (95% confidence interval (CI) 0.59–0.82). Interpretation: Treatment with SGLT2 inhibitors after myocardial infarction in patients with type 2 diabetes was associated with a lower rate of cardiovascular events.

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author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Heart failure, Myocardial infarction, Sodium-glucose co-transporter-2 (SGLT2) inhibitors, SWEDEHEART, Type 2 diabetes mellitus
in
The Lancet Regional Health - Europe
volume
45
article number
101032
publisher
Elsevier
external identifiers
  • pmid:39262451
  • scopus:85201486554
ISSN
2666-7762
DOI
10.1016/j.lanepe.2024.101032
language
English
LU publication?
yes
id
c9ab99bd-df59-4e7f-87e2-44fa55bd42d2
date added to LUP
2024-10-30 13:29:49
date last changed
2025-01-22 22:18:58
@article{c9ab99bd-df59-4e7f-87e2-44fa55bd42d2,
  abstract     = {{<p>Background: Sodium-glucose co-transporter 2 (SGLT2) inhibitors have been shown to reduce rates of heart failure hospitalisations and cardiovascular death in patients with type 2 diabetes and prior cardiovascular disease. We hypothesised that SGLT2 inhibitors could provide cardiovascular benefits in the post-myocardial infarction setting. We aimed to investigate cardiovascular outcomes of SGLT2 inhibitor therapy in patients with type 2 diabetes mellitus after myocardial infarction in a Swedish nationwide registry. Methods: We included all patients with type 2 diabetes surviving a type 1 acute myocardial infarction from January 1, 2018 to December 31, 2021. Patients were included if they were discharged with an estimated glomerular filtration rate (eGFR) &gt; 30 mL/min/1.73 m<sup>2</sup> in the nationwide Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies (SWEDEHEART) registry. We identified all patients discharged with or without an SGLT2 inhibitor prescription 120 days before or within three days after discharge from the cardiac care unit. The primary outcome measure was a composite of death and first hospitalisation for heart failure after one year analysed using an adjusted Cox regression. Findings: A total of 11,271 patients were included. Of these, 2498 (22.2%) received SGLT2 inhibitor treatment. Patients who were prescribed SGLT2 inhibitors were younger, more often presented with a STEMI and had worse left ventricular ejection fraction at index hospitalisation. SGLT2 inhibitor use was associated with lower rates of the composite outcome (hazard ratio (HR) of 0.70 (95% confidence interval (CI) 0.59–0.82). Interpretation: Treatment with SGLT2 inhibitors after myocardial infarction in patients with type 2 diabetes was associated with a lower rate of cardiovascular events. <br/></p>}},
  author       = {{Rosén, Hans Christian and Mohammad, Moman A. and Jernberg, Tomas and James, Stefan and Oldgren, Jonas and Erlinge, David}},
  issn         = {{2666-7762}},
  keywords     = {{Heart failure; Myocardial infarction; Sodium-glucose co-transporter-2 (SGLT2) inhibitors; SWEDEHEART; Type 2 diabetes mellitus}},
  language     = {{eng}},
  publisher    = {{Elsevier}},
  series       = {{The Lancet Regional Health - Europe}},
  title        = {{SGLT2 inhibitors for patients with type 2 diabetes mellitus after myocardial infarction : a nationwide observation registry study from SWEDEHEART}},
  url          = {{http://dx.doi.org/10.1016/j.lanepe.2024.101032}},
  doi          = {{10.1016/j.lanepe.2024.101032}},
  volume       = {{45}},
  year         = {{2024}},
}