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Zhou, Zien; Jardine, Meg J.; Li, Qiang; Neuen, Brendon L.; Cannon, Christopher P.; de Zeeuw, Dick; Edwards, Robert; Levin, Adeera; Mahaffey, Kenneth W.; Perkovic, Vlado; Neal, Bruce; Lindley, Richard I.; Ahuad Guerrero, Rodolfo Andres; Aizenberg, Diego; Albisu, Juan Pablo; Alvarisqueta, Andres; Bartolacci, Ines; Berli, Mario Alberto; Bordonava, Anselmo; Calella, Pedro; Cantero, Maria Cecilia; Cartasegna, Luis Rodolfo; Cercos, Esteban; Coloma, Gabriela Cecilia; [...]

Effect of SGLT2 Inhibitors on Stroke and Atrial Fibrillation in Diabetic Kidney Disease : Results From the CREDENCE Trial and Meta-Analysis : Results From the CREDENCE Trial and Meta-Analysis

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  • Medientyp: E-Artikel
  • Titel: Effect of SGLT2 Inhibitors on Stroke and Atrial Fibrillation in Diabetic Kidney Disease : Results From the CREDENCE Trial and Meta-Analysis : Results From the CREDENCE Trial and Meta-Analysis
  • Beteiligte: Zhou, Zien; Jardine, Meg J.; Li, Qiang; Neuen, Brendon L.; Cannon, Christopher P.; de Zeeuw, Dick; Edwards, Robert; Levin, Adeera; Mahaffey, Kenneth W.; Perkovic, Vlado; Neal, Bruce; Lindley, Richard I.; Ahuad Guerrero, Rodolfo Andres; Aizenberg, Diego; Albisu, Juan Pablo; Alvarisqueta, Andres; Bartolacci, Ines; Berli, Mario Alberto; Bordonava, Anselmo; Calella, Pedro; Cantero, Maria Cecilia; Cartasegna, Luis Rodolfo; Cercos, Esteban; Coloma, Gabriela Cecilia; [...]
  • Erschienen: Ovid Technologies (Wolters Kluwer Health), 2021
  • Erschienen in: Stroke
  • Sprache: Englisch
  • DOI: 10.1161/strokeaha.120.031623
  • ISSN: 0039-2499; 1524-4628
  • Schlagwörter: Advanced and Specialized Nursing ; Cardiology and Cardiovascular Medicine ; Neurology (clinical)
  • Entstehung:
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  • Beschreibung: <jats:sec> <jats:title>Background and Purpose:</jats:title> <jats:p>Chronic kidney disease with reduced estimated glomerular filtration rate or elevated albuminuria increases risk for ischemic and hemorrhagic stroke. This study assessed the effects of sodium glucose cotransporter 2 inhibitors (SGLT2i) on stroke and atrial fibrillation/flutter (AF/AFL) from CREDENCE (Canagliflozin and Renal Events in Diabetes With Established Nephropathy Clinical Evaluation) and a meta-analysis of large cardiovascular outcome trials (CVOTs) of SGLT2i in type 2 diabetes mellitus.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods:</jats:title> <jats:p>CREDENCE randomized 4401 participants with type 2 diabetes mellitus and chronic kidney disease to canagliflozin or placebo. Post hoc, we estimated effects on fatal or nonfatal stroke, stroke subtypes, and intermediate markers of stroke risk including AF/AFL. Stroke and AF/AFL data from 3 other completed large CVOTs and CREDENCE were pooled using random-effects meta-analysis.</jats:p> </jats:sec> <jats:sec> <jats:title>Results:</jats:title> <jats:p> In CREDENCE, 142 participants experienced a stroke during follow-up (10.9/1000 patient-years with canagliflozin, 14.2/1000 patient-years with placebo; hazard ratio [HR], 0.77 [95% CI, 0.55–1.08]). Effects by stroke subtypes were: ischemic (HR, 0.88 [95% CI, 0.61–1.28]; n=111), hemorrhagic (HR, 0.50 [95% CI, 0.19–1.32]; n=18), and undetermined (HR, 0.54 [95% CI, 0.20–1.46]; n=17). There was no clear effect on AF/AFL (HR, 0.76 [95% CI, 0.53–1.10]; n=115). The overall effects in the 4 CVOTs combined were: total stroke (HR <jats:sub>pooled</jats:sub> , 0.96 [95% CI, 0.82–1.12]), ischemic stroke (HR <jats:sub>pooled</jats:sub> , 1.01 [95% CI, 0.89–1.14]), hemorrhagic stroke (HR <jats:sub>pooled</jats:sub> , 0.50 [95% CI, 0.30–0.83]), undetermined stroke (HR <jats:sub>pooled</jats:sub> , 0.86 [95% CI, 0.49–1.51]), and AF/AFL (HR <jats:sub>pooled</jats:sub> , 0.81 [95% CI, 0.71–0.93]). There was evidence that SGLT2i effects on total stroke varied by baseline estimated glomerular filtration rate ( <jats:italic>P</jats:italic> =0.01), with protection in the lowest estimated glomerular filtration rate (&lt;45 mL/min/1.73 m <jats:sup>2</jats:sup> ]) subgroup (HR <jats:sub>pooled</jats:sub> , 0.50 [95% CI, 0.31–0.79]). </jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions:</jats:title> <jats:p>Although we found no clear effect of SGLT2i on total stroke in CREDENCE or across trials combined, there was some evidence of benefit in preventing hemorrhagic stroke and AF/AFL, as well as total stroke for those with lowest estimated glomerular filtration rate. Future research should focus on confirming these data and exploring potential mechanisms.</jats:p> </jats:sec> <jats:sec> <jats:title>Registration:</jats:title> <jats:p> URL: <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="https://www.clinicaltrials.gov">https://www.clinicaltrials.gov</jats:ext-link> ; Unique identifier: NCT02065791. </jats:p> </jats:sec>
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