Effects of canagliflozin on myocardial infarction: a post hoc analysis of the CANVAS Program and CREDENCE trial
Author(s)
Type
Journal Article
Abstract
AIMS: Given the benefits of sodium glucose co-transporter 2 inhibition (SGLT2i) in protecting against heart failure in diabetic patients, we sought to explore the potential impact of SGLT2i on the clinical features of patients presenting with myocardial infarction (MI) through a post-hoc analysis of CANVAS Program and CREDENCE trial. METHODS AND RESULTS: Individuals with type 2 diabetes and history or high risk of cardiovascular disease (CANVAS Program) or type 2 diabetes and chronic kidney disease (CREDENCE) were included. The intervention was Canagliflozin 100 or 300 mg (combined in the analysis) or placebo. MI events were adjudicated as ST-elevation myocardial infarction (STEMI), non-STEMI as well as type 1 MI or type 2 MI. 421 first MI events in the CANVAS Program and 178 first MI events in the CREDENCE trial were recorded (83 fatal, 128 STEMI, 431 non-STEMI, and 40 unknown). No benefit of canagliflozin compared with placebo on time to first MI event was observed (HR 0.89; 95% CI 0.75, 1.05). Canagliflozin was associated with lower risk for non-STEMI (HR 0.78; 95% CI 0.65, 0.95) but suggested a possible increase in STEMI (HR 1.55; 95% CI 1.06, 2.27), with no difference in risk of type 1 or type 2 MI. There was no change in fatal MI (HR 1.22, 95% CI 0.78, 1.93). CONCLUSIONS: Canagliflozin was not associated with a reduction in overall MI in the pooled CANVAS Program and CREDENCE trial population. The possible differential effect on STEMI and Non-STEMI observed in the CANVAS cohort warrants further investigation.
Date Issued
2022-03
Date Acceptance
2021-04-06
Citation
Cardiovascular Research, 2022, 118 (4), pp.1103-1114
ISSN
0008-6363
Publisher
European Society of Cardiology
Start Page
1103
End Page
1114
Journal / Book Title
Cardiovascular Research
Volume
118
Issue
4
Copyright Statement
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: journals.permissions@oup.com. This is a pre-copy-editing, author-produced version of an article accepted for publication in Cardiovascular Research following peer review. The definitive publisher-authenticated version is available online at: https://academic.oup.com/cardiovascres/advance-article/doi/10.1093/cvr/cvab128/6214523
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/33826709
PII: 6214523
Subjects
Canagliflozin
SGLT2 inhibitor
heart failure
randomized trial
type 2 diabetes
Publication Status
Published
Coverage Spatial
England
Date Publish Online
2021-04-07