Adverse cardiovascular and kidney outcomes in people with SARS-CoV-2 treated with SGLT2 inhibitors

Abstract

Whether use of SGLT2 inhibitors reduces the risk of cardiovascular and kidney events in people who contracted SARS-CoV-2 infection is not clear. We used the healthcare databases of the United States Department of Veterans Affairs to build a cohort of 107,776 participants on antihyperglycemic therapy and had SARS-CoV-2 infection between March 01, 2020 and June 10, 2023. Within them, 11,588 used SGLT2 inhibitors and 96,188 used other antihyperglycemics. We examined the risks of major adverse cardiovascular events (MACE)—a composite of death, myocardial infarction and stroke, and major adverse kidney events (MAKE)—a composite of death, eGFR decline > 50%, and end stage kidney disease after balancing baseline characteristics between groups through inverse probability weighting. Survival analyses were conducted to generate hazard ratio (HR) and absolute risk reduction per 100 person-years (ARR). Over a median follow up of 1.57 (IQR: 1.05–2.49) years, compared to the control group, SGLT2 inhibitors use is associated with reduced risk of MACE (HR 0.82 (0.77, 0.88), ARR 1.73 (1.21, 2.25)) and reduced risk of MAKE (HR 0.75 (0.71, 0.80), ARR 2.62 (2.13, 3.11)). Compared to the control group, SGLT2 inhibitors use is associated with reduced risk of the secondary outcomes of hospitalization (HR 0.94 (0.90, 0.98), ARR 1.06 (1.36, 1.76)), anemia (HR 0.71 (0.65, 0.76), ARR 2.43 (1.95, 2.90)), and acute kidney injury (HR 0.84 (0.79, 0.89), ARR 1.86 (1.29, 2.42)). Among people with SARS-CoV-2 infection on antihyperglycemic therapy, compared to those on other antihyperglycemics, those on SGLT2 inhibitors have less risk of adverse cardiovascular and kidney outcomes. SARS-CoV-2 infection leads to significant increase in risk of heart and kidney problems both shortly after infection and in the long-term. In this study, we evaluated whether SGLT2 inhibitors could reduce the risk of major adverse heart and kidney events in people with SARS-CoV-2 infection. SGLT2 inhibitors are a type of medication used to treat diabetes by lowering the amount of sugar in the blood. We compared a large group of people during and after SARS-CoV-2 infection and found that those who were using SGLT2 inhibitors had less major adverse heart and kidney problems than those who were using other types of sugar-lowering medications. Our findings could be useful for optimizing approaches to reduce risk of heart and kidney problems among people with diabetes and SARS-CoV-2 infection. Choi et al. report on the effectiveness of SGLT2 inhibitors in reducing risk of major adverse cardiovascular events (MACE) and major adverse kidney events (MAKE) in people with SARS-CoV-2 infection. They show that compared to other antihyperglycemics, SGLT2 inhibitors reduce the risk of both MACE and MAKE after SARS-CoV-2 infection.