Pump, pipes, and filter: do SGLT2 inhibitors cover it all?

• Published in: The Lancet (British edition) Vol. 393; no. 10166; pp. 3 - 5
• Main Authors: Verma, Subodh, Jüni, Peter, Mazer, C David
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 05.01.2019; Elsevier Limited
• Subjects: Arteriosclerosis; Atherosclerosis; Biosensors; Congestive heart failure; Coronary artery disease; Cost analysis; Diabetes; Diabetes mellitus; Diabetes mellitus (non-insulin dependent); Disease prevention; Drug therapy; Health risk assessment; Heart; Heart failure; Heterogeneity; Kidney diseases; Meta-analysis; Pharmacology; Renal failure; Risk analysis; Risk factors; Risk management; Systematic review; Vascular diseases
• ISSN: 0140-6736; 1474-547X; 1474-547X
• DOI: 10.1016/S0140-6736(18)32824-1

[...]SGLT2i offered modest but significant reductions in major adverse cardiovascular events observed exclusively in people with type 2 diabetes and atherosclerotic vascular disease (0·86 [0·80–0·93]) but not in those with multiple risk factors (1·00 [0·87–1·16]).6 The conceptual separation of primary versus secondary prevention is firmly engrained when contemplating populations at risk, although the appropriateness of applying such a divide to define the use of risk reduction pharmacotherapies is questionable. Since the latest American Diabetes Association—European Association for the Study of Diabetes joint position statement has prioritised the use of SGLT2i in people with atherosclerotic vascular disease, heart failure, or chronic kidney disease,10 is it time to suggest that SGLT2i should be considered in an even broader population of people with type 2 diabetes and multiple risk factors? [...]the meta-analyses of cardiovascular and all-cause death show a high degree of heterogeneity between trials.