title: Cardiovascular effects of dapagliflozin in patients with type 2 diabetes and different risk categories: a meta-analysis.
abstract: BACKGROUND
  A pre-specified meta-analysis of cardiovascular (CV) events from 21 phase 2b/3 dapagliflozin clinical trials was undertaken to characterise the CV profile of dapagliflozin. This showed no increase in CV risk with dapagliflozin compared with control (placebo or comparator treatment) with or without background glucose-lowering therapies. The analysis reported here aimed to characterise the CV profile of dapagliflozin in subgroups of patients in these 21 studies grouped by degree of CV risk, based on both baseline and in-study risk factors (including hypoglycaemic events), with a focus on major adverse CV events (MACE).
  
  
  METHODS
  Patients with type 2 diabetes, both overall and with different levels of CV risk, including CV disease (CVD) history, age and other CV risk factors, were analysed. A further analysis compared CV risk in patients who experienced a hypoglycaemic event prior to MACE and those who did not. Analyses were based on time to first event using a Cox proportional hazards model stratified by study comparing dapagliflozin versus control.
  
  
  RESULTS
  In total, 9339 patients were included in this meta-analysis; 5936 patients received dapagliflozin 2.5-10 mg (6668 patient-years) and 3403 received control (3882 patient-years). Dapagliflozin is not associated with increased CV risk and results further suggest the potential for a beneficial effect both in the overall population [Hazard Ratio (HR) 0.77; 95 % CI (0.54, 1.10) for MACE] and in those with a history of CVD [HR 0.80 (0.53, 1.22)]. These findings were consistent in patients with varying degrees of CV risk, including age, number and type of CVD events in medical history and number of CV risk factors present. Furthermore, there was no increased risk of MACE in patients who experienced a hypoglycaemic event compared with those who did not.
  
  
  CONCLUSIONS
  There was no suggestion of increased risk for MACE with dapagliflozin compared with control in any of the populations investigated. In addition, the results suggest the potential for a beneficial CV effect which is consistent with the multifactorial benefits on CV risk factors associated with sodium-glucose cotransporter-2 (SGLT2) inhibitors.
authors.affiliation: AstraZeneca Gothenburg, Pepparedsleden 1, SE-431 83, Mölndal, Sweden. Christian.Sonesson@astrazeneca.com.
authors.forename: Christian
authors.initials: C
authors.lastname: Sonesson
authors.affiliation: AstraZeneca Gothenburg, Pepparedsleden 1, SE-431 83, Mölndal, Sweden. Peter.A.Johansson@astrazeneca.com.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Johansson
authors.affiliation: AstraZeneca Gothenburg, Pepparedsleden 1, SE-431 83, Mölndal, Sweden. Eva.Johnsson@astrazeneca.com.
authors.forename: Eva
authors.initials: E
authors.lastname: Johnsson
authors.affiliation: AstraZeneca Gothenburg, Pepparedsleden 1, SE-431 83, Mölndal, Sweden. Ingrid.Gause-Nilsson@astrazeneca.com.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Gause-Nilsson
mesh_terms: D000368:Aged; D001559:Benzhydryl Compounds / Q000009:adverse effects / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D017322:Clinical Trials, Phase II as Topic; D017326:Clinical Trials, Phase III as Topic; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D005960:Glucosides / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D065840:Protective Factors; D018570:Risk Assessment; D012307:Risk Factors; D051247:Sodium-Glucose Transport Proteins / Q000037:antagonists & inhibitors / Q000378:metabolism; D016896:Treatment Outcome
chemical_list: D001559:Benzhydryl Compounds; D015415:Biomarkers; D001786:Blood Glucose; D005960:Glucosides; D007004:Hypoglycemic Agents; D051247:Sodium-Glucose Transport Proteins; C529054:dapagliflozin