Canagliflozin linked to fewer deaths, heart failure hospitalizations for type 2 diabetics

Canagliflozin reduced the risk of death or hospitalization for heart failure by 22 percent among patients with type 2 diabetes and a high risk of cardiovascular disease, according to results of the CANVAS trial presented March 11 at the American College of Cardiology’s scientific session and published simultaneously in Circulation.

The trial enrolled 10,142 participants with type 2 diabetes and randomized them to treatment with canagliflozin—either 100 or 300 mg per day—or a placebo. Regardless of dose, patients taking the sodium glucose cotransporter-2 (SGLT-2) inhibitor met the primary endpoint of death or hospitalization from heart failure 16.3 times per 1,000 patient years. Those taking the placebo had an event rate of 20.8 per 1,000 years—a 22 percent increase.

Dosage didn’t make a difference, according to the researchers, with both the 100 mg and 300 mg arms of the trial showing an equal risk reduction over the average follow-up of 188 weeks.

In addition, the medication was determined to be particularly helpful for patients who had a history of heart failure at baseline. They showed a 39 percent risk reduction for the primary endpoint versus a 13 percent reduction in those who began the trial without heart failure.

“The benefits for heart failure outcomes appeared early during follow-up, suggesting a mode of action driven primarily by volume and hemodynamic effects,” wrote lead authors Karin Radholm, MD, PhD, and Gemma Figtree, MBBS, DPhil, and colleagues.

“Reductions in preload and afterload stemming from natriuresis, systemic blood pressure lowering, modification of the intrarenal renin angiotensin axis, and reduction in arterial stiffness may all contribute to the protection afforded. Preservation of renal function and the mitigation of volume overload achieved with SGLT2 inhibition also probably contributed to the observed reduction in heart failure risk.”

The researchers noted the benefits of canagliflozin were seen across multiple subgroups, including among patients who were also using other treatments for heart failure.