Benefit of early treatment with dapagliflozin in primary prevention in patients with type 2 diabetes mellitus

Overview

Cardiovascular disease (CVD) is the leading cause of mortality in patients with type 2 diabetes mellitus (T2D). Together with myocardial infarction (MI) and stroke, they account for 80% of all deaths. Therefore, it is important that antidiabetic drugs are indicated early to reduce cardiovascular (CV) risk factors, CV morbidity and mortality, and progression of diabetic nephropathy. Dapagliflozin 10 mg compared with placebo demonstrated noninferiority for the composite endpoint of CV-caused death, MI, or ischemic stroke. Dapagliflozin 10 mg compared with placebo demonstrated superiority for the prevention of the indicator composite of hospitalization for heart failure or death from CV causes. Among patients with chronic kidney disease, regardless of the presence or absence of diabetes, the risk of the combination of a sustained decline in estimated GFR of at least 50%, end-stage renal disease, or death from renal or CV causes was significantly lower with dapagliflozin than with placebo. Among heart failure patients with reduced ejection fraction, the risk of worsening heart failure or death from CV causes was lower among those taking dapagliflozin than among those taking placebo, regardless of the presence or absence of diabetes. International recommendations for the treatment of T2D include sodium-glucose cotransporter-2 inhibitors (SGLT2i) as secondary prevention in patients with confirmed atherosclerotic cardiovascular disease (ASCVD) or for primary prevention of CV events in high-risk patients with multiple risk factors for ASCVD.
 

Keywords:

atherosclerotic cardiovascular disease (ASCVD) – chronic kidney disease – dapagliflozin – type 2 diabetes mellitus (T2D) – diabetic nephropathy – sodium-glucose cotransporter-2 inhibitors – type 2 diabetes mellitus (SGLT2i)