Cardiovascular and renal outcomes with SGLT2 inhibitors: Real-life observational studies in older patients with type 2 diabetes

Patients with type 2 diabetes mellitus (T2DM) are exposed to a high risk of atherosclerotic cardiovascular disease, heart failure and chronic kidney disease. The incidence of these complications increases markedly with the duration of diabetes and aging. Sodium-glucose cotransporter 2 inhibitors (SGLT2is) showed a remarkable reduction in hospitalization for heart failure and progression of kidney disease in large prospective placebo-controlled trials. Post hoc analyses of these trials demonstrated that cardiorenal protection occurred independently of age. The present comprehensive review analyzes the effects of SGLT2is on cardiovascular and renal outcomes among older patients with T2DM in cohort studies and real-life conditions. SGLT2is were associated with a significant reduction in hospitalization for heart failure (alone or combined with mortality) and in a composite renal outcome, including end-stage renal disease when compared to other oral glucose-lowering drugs, dipeptidyl peptidase-4 inhibitors and glucagon-like peptide-1 receptor agonists in patients aged ≥ 65 years and even ≥ 75 years. Several observational studies worldwide compared cardiorenal outcomes in people aged ≥ 65 years versus < 65 years and showed a similar relative benefit of SGLT2is in older versus younger patients with T2DM. These favourable results were obtained while the safety profile of SGLT2is in older patients was acceptable and almost comparable with that reported in younger patients. In conclusion, observational studies in real-life conditions confirm previous results reported in placebo-controlled trials and a positive benefit/risk balance in elderly patients with T2DM at risk of heart failure and chronic kidney disease.