Do SGLT2 inhibitors reduce heart disease compared to DPP-4 inhibitors?

This study compared the effects on heart disease for SGLT2 inhibitors vs DPP-4 inhibitors in patients with type 2 diabetes (T2D). It found that patients using SGLT2 inhibitor medications had lower rates of heart failure, heart attack, and stroke.

T2D is a disorder of high levels of glucose (sugar) in the blood. T2D is connected to obesity and changes in metabolism. People with T2D have a higher risk of heart attack, stroke, and other cardiovascular problems.

Sodium-glucose transporter-2 (SGLT2) inhibitors are a class of medications for diabetes. Examples of SGLT2 inhibitors include dapagliflozin (Farxiga), empagliflozin (Jardiance), and canagliflozin (Invokana). SGLT2 inhibitors cause glucose to pass out of the body in the urine, which lowers blood glucose levels. 

DPP-4 inhibitors are another class of diabetes medications. These medications increase the amount of GLP-1 hormone, which regulates how the body responds to meals. DPP-4 inhibitors include sitagliptin (Januvia) and linagliptin (Tradjenta).

It is not clear whether SGLT2 inhibitors can lower the risk of heart disease when compared to DPP-4 inhibitors.

This study included 193,124 patients with T2D who started taking an SGLT2 inhibitor and an equal number of patients who began taking a DPP-4 inhibitor. Each patient was compared to a patient with a similar age and medical history taking the other medication. 30.1% of patients already had heart disease at the start of the study. 

Patients taking SGLT2 inhibitors had a 31% lower risk of being hospitalized for heart failure. Additionally, patients taking SGLT2 inhibitors had a 12% lower risk of heart attack and a 15% lower risk of stroke. The overall risk of death was 36% lower for patients taking SGLT2 inhibitors.

This study found that patients with T2D taking SGLT2 inhibitors had a lower risk of heart failure, heart attack, and stroke than patients taking DPP-4 inhibitors.

This study was funded by AstraZeneca, the manufacturer of Farxiga. In 2019, Farxiga received an additional FDA approval for use to reduce heart failure in patients with T2D.