SGLT-2 inhibitor, cardiovascular risk and outcome in patients with comorbidity of hypertension and diabetes

Context Two thirds of diabetes patients complicated with hypertension, and comorbidity increase 4-fold risk of atherosclerotic cardiovascular disease (ASCVD). Sodium-glucose transporter 2 (SGLT-2) inhibitors have been proved to decrease the cardiovascular adverse events in several large randomized controlled trials (RCTS), but evidence limited to patients with type 2 diabetes and ASCVD.

Objective This study aims to investigate the effects of SGLT-2 inhibitors on level of cardiovascular risk (evaluate by China-PAR) and hospitalization events in patient with comorbidity of hypertension and diabetes.

Study design and analysis This is a multiple-center retrospective real-world cohort study. Propensity score matching and multivariate Cox proportional hazard regression model were conducted.

Setting or Dataset Five electronic systems of community clinic.

Population Studied individuals with comorbidity of hypertension and type 2 diabetes.

Intervention Taking SGLT-2 inhibitors more than 3 months.

Outcome Measures Changes of China-PAR score and cardiovascular hospitalization events.

Results After propensity score matching, a total of 3546 individuals with average age of 70 years were included, and 388 (10.94%) individuals were treated by SGLT-2 inhibitors. During the 1 year follow-up, 607 (17.12%) and 453 (12.77%) individuals were hospitalized due to cardiovascular events and stroke, respectively. SGLT-2 inhibitors group had significant lower increment of China-PAR scores (P=0.001) compared to control group. Moreover, SGLT-2 inhibitors significantly decrease the all-cause hospitalization (HR 0.548, 95%CI 0.346-0.869, P=0.010), cardiovascular events hospitalization (HR 0.637, 95%CI 0.439-0.978, P=0.043), and stroke hospitalization (HR 0.466, 95%CI 0.275-0.781, P=0.004).

Conclusions SGLT-2 inhibitors are beneficial for inhibiting the increase of cardiovascular risk, and reducing cardiovascular event related hospitalization, especially stroke, in individuals with comorbidity of hypertension and type 2 diabetes.