| Title: |
Effect of SGLT2 inhibitors on stroke and atrial fibrillation in diabetic kidney disease: Results from the CREDENCE trial and meta-analysis |
| Authors: |
Zhou, Z; Jardine, MJ; Li, Q; Neuen, BL; Cannon, CP; De Zeeuw, D; Edwards, R; Levin, A; Mahaffey, KW; Perkovic, V; Neal, B; Lindley, RI; Guerrero, RAA; Aizenberg, D; Albisu, JP; Alvarisqueta, A; Bartolacci, I; Berli, MA; Bordonava, A; Calella, P; Cantero, MC; Cartasegna, LR; Cercos, E; Coloma, GC; Colombo, H; Commendatore, V; Cuadrado, J; Cuneo, CA; Cusumano, AM; Douthat, WG; Dran, RD; Farias, E; Fernandez, MF; Finkelstein, H; Fragale, G; Fretes, JO; Garcia, NH; Gastaldi, A; Gelersztein, E; Glenny, JA; Gonzalez, JP; Del Carmen Gonzalez Colaso, P; Goycoa, C; Greloni, GC; Guinsburg, A; Hermida, S; Juncos, LI; Klyver, MI; Kraft, F; Krynski, F; Lanchiotti, PV; De La Fuente, RAL; Marchetta, N; Mele, P; Nicolai, S; Novoa, PA; Orio, SI; Otreras, F; Oviedo, A; Raffaele, P; Resk, JH; Rista, L; Papini, NR; Sala, J; Santos, JC; Schiavi, LB; Sessa, H; Casabella, TS; Ulla, MR; Valdez, M; Vallejos, A; Villarino, A; Visco, VE; Wassermann, A; Zaidman, CJ; Cheung, NW; Droste, C; Fraser, I; Johnson, D; Mah, PM; Nicholls, K; Packham, D; Proietto, J; Roberts, A; Roger, S; Tsang, V; Raduan, RA; Da Costa, FAA; Amodeo, C; Turatti, LAA; Bregman, R; Sanches, FCC; Canani, LH; Chacra, AR; Borges, JLC; Vêncio, SAC; Da Silva Franco, RJ; D'Avila, D; De Souza Portes, E; De Souza, P |
| Publisher Information: |
LIPPINCOTT WILLIAMS & WILKINS |
| Publication Year: |
2021 |
| Collection: |
The University of Melbourne: Digital Repository |
| Description: |
BACKGROUND AND PURPOSE: 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. METHODS: 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. RESULTS: 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 (HRpooled, 0.96 [95% CI, 0.82-1.12]), ischemic stroke (HRpooled, 1.01 [95% CI, 0.89-1.14]), hemorrhagic stroke (HRpooled, 0.50 [95% CI, 0.30-0.83]), undetermined stroke (HRpooled, 0.86 [95% CI, 0.49-1.51]), and AF/AFL (HRpooled, 0.81 [95% CI, 0.71-0.93]). There was evidence that SGLT2i effects on total stroke varied by baseline estimated glomerular filtration rate (P=0.01), with protection in the lowest estimated glomerular filtration rate ( |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| ISSN: |
0039-2499 |
| Relation: |
https://hdl.handle.net/11343/287718 |
| Availability: |
https://hdl.handle.net/11343/287718 |
| Rights: |
https://creativecommons.org/licenses/by-nc-nd/4.0 ; CC BY-NC-ND |
| Accession Number: |
edsbas.D148DBC7 |
| Database: |
BASE |