Study finds SGLT2 inhibitors safer for heart than DPP4s in the elderly

A new study has found that older people with type 2 diabetes, taking a sodium-glucose co-transporter 2 (SGLT2) inhibitor for glucose management, had a lower occurrence of heart failure than those using alternative dipeptidyl peptidase-4 (DPP4) inhibitor drugs.
Heart failure is the inability of the heart to pump sufficient blood to supply the body with oxygen, a condition that people with type 2 diabetes can be subjected to.
The ‘Healthcore’ research, led by the American insurance company, Anthem Inc, focuses on the comparative effectiveness of SGLT2 inhibitors versus DPP-4 inhibitors in heart failure and its implications for treating the elderly with a history of heart disease or complications.
Previous research suggested that treatment with SGLT2is, like Jardiance (empagliflozin), Forxiga (dapagliflozin) or Invokana (canagliflozin), can cut heart failure and death rates.
Empagliflozi, especially, demonstrated a 38 per cent risk reducton in cardiovascular death for patients with type 2 diabetes. Here, researchers reviewed data specifically related to the development of heart failure.
They looked at heart failure outcomes in 4,899 people newly prescribed a SGLT2i and 9,798 people recently put on a DPP-4i between April 2013 and December 2014. Both groups were followed for approximately two years.
The findings, published in the journal Cardiovascular Diabetology, show significant reductions in heart failure admissions observed with SGLT2is amongst older patients at higher risk of recurrent heart failure.
They have found that the heart hospitalisation risk is about 32 per cent lower for new users of SGLT2is, compared to DPP-4 medications. However, in patients younger than 65 or without history of complications, it made no difference.
Those effects fail to explain fully this reduction in heart failure readmissions. SGLT2is may have a unique pharmacological profile in that they affect blood flow, the nervous system, the metabolism and the vascular system to lower risks.
The use of SGLT2is in type 2 diabetes has been associated with decreased vascular stiffness and improved endothelial function, for example.
Moreover, SGLT2is might improve the efficiency of the failing heart by encouraging a switch to an alternative fuel to generate energy, the ketone body beta-hydroxybutyrate, which increases oxygen transport – impaired during heart failure.
Whether this is a productive versus a faulty adaptive fuel shift is however still to be determined. Overall, this study suggests that the preferred blood sugar-lowering drug to for older patients with type 2 diabetes and a history of heart failure should be SGLT2is.