Diabetes Patients May Reduce Cardiovascular Disease Risk Depending on Treatment

Seoul National University Hospital, Comparison of Cardiovascular Disease Reduction Effects of SGLT-2 Inhibitors

A study has found that the prognosis of cardiovascular disease in patients may vary depending on the sodium-glucose co-transporter (SGLT)-2 inhibitor class of diabetes medication used.

[Image provided by Pixabay]

Seoul National University Hospital announced that a joint research team consisting of Professors Kim Hyung-kwan and Lee Hee-sun from the Department of Cardiology at Seoul National University Hospital, and Professor Choi Yoo-jung from Korea University Guro Hospital (with doctoral candidate Lim Jae-hyun from Seoul National University College of Medicine) reached this conclusion after comparing the effects of reducing cardiovascular disease risk. The study tracked 145,504 diabetic patients using the two most commonly prescribed SGLT-2 inhibitors in Korea and analyzed the effects according to the medication used.

This class of drugs lowers blood sugar by inhibiting the 'sodium-glucose co-transporter-2' that induces glucose reabsorption in the kidneys, allowing glucose to be excreted through urine. The SGLT-2 inhibitor class has been reported to reduce the risk of cardiovascular disease, attracting attention in the medical community. However, studies on the cardiovascular disease reduction effects of SGLT-2 inhibitors have mainly targeted patients with severe complications such as myocardial infarction and stroke or Western populations, and it has not been studied whether mild Asian patients can achieve the same effects.

To analyze this, the research team divided about 140,000 mild diabetic patients in Korea who were first prescribed SGLT-2 inhibitors between 2016 and 2018 into two groups based on the medication used: the 'Dapagliflozin' group and the 'Empagliflozin' group. They then followed up for about two years to compare the risk of occurrence of four diseases?heart failure, stroke, myocardial infarction, and cardiovascular disease?between the two groups.

Graph comparing the risk of cardiovascular disease events in the group using sodium-glucose co-transporter (SGLT)-2 inhibitors. [Image provided by Seoul National University Hospital]

The study results showed that the Dapagliflozin group had a 16% lower risk of heart failure and a 24% lower risk of death from cardiovascular disease compared to the Empagliflozin group. Regarding this, the research team explained, "The neurohormonal responses induced by the two drugs differ, and Dapagliflozin has a relatively higher affinity for SGLT-2." A higher SGLT-2 affinity means the drug binds better to this protein, potentially enhancing its effect. However, the research team added that additional studies comparing the two drugs are needed to prove the mechanistic differences between Dapagliflozin and Empagliflozin.

There was no difference in the risk of stroke and myocardial infarction between the two groups. The overall risk of the four diseases was slightly lower in the Dapagliflozin group than in the Empagliflozin group, but the difference was not statistically significant. Drug safety, evaluated by the occurrence of side effects, was also the same. Since the overall impact on cardiovascular disease occurrence is the same for both drugs, the research team emphasized that the study results should be interpreted with caution.

Professor Kim Hyung-kwan of Seoul National University Hospital said, "The two types of SGLT-2 inhibitors that reduce cardiovascular disease are excellent drugs that are preferentially recommended not only in Korea but also in global diabetes treatment guidelines," adding, "The greatest significance of this study is that it analyzed large-scale clinical data of Asians and mild patients with low cardiovascular disease risk, who have been relatively underrepresented in previous SGLT-2 inhibitor studies."

Professor Lee Hee-sun of Seoul National University Hospital Gangnam Center also said, "The fact that the prognosis of two very commonly prescribed drugs in actual clinical practice may differ is expected to help establish more specific treatment guidelines in the future." Professor Choi Yoo-jung of Korea University Guro Hospital and specialist Lim Jae-hyun said, "Diabetes is a common disease occurring in about one in seven adults over 30 in Korea," and added, "We hope that the results of this study, derived from large-scale domestic data, will help patients and medical professionals in selecting medications."

The study results were published in the latest issue of the international journal Cardiovascular Diabetology (IF: 9.6).

Professor Kim Hyung-kwan of Seoul National University Hospital, Professor Lee Hee-sun of Seoul National University Hospital Gangnam Center, Professor Choi Yoo-jung of Korea University Guro Hospital, and PhD candidate Lim Jae-hyun of Seoul National University College of Medicine. (From left to right).
[Photo by Seoul National University Hospital]

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