Studies Suggest Diabetes Drugs Help Hearts and Kidneys for People With or Without Diabetes
By Matthew Garza, Eliza Skoler, and Joseph Bell
Latest results presented at the European Society of Cardiology conference show that SGLT-2 inhibitor therapies Jardiance and Farxiga clearly lead to heart and kidney health
Last weekend’s virtual European Society of Cardiology 2020 “The Digital Experience” conference (a free meeting with 116,000 attendees from 51 countries!) highlighted the growing treatment possibilities for SGLT-2 inhibitor drugs. The newest results show that this class of medication can help many people affected by heart disease and kidney disease, whether or not they have diabetes.
Jardiance Reduces Risk of Heart Failure, Cardiovascular Death, and Kidney Decline
To kick off the conference, Dr. Milton Packer from the Baylor College of Medicine presented exciting new results on the heart health effects of Jardiance. Jardiance, an SGLT-2 inhibitor drug traditionally used to lower glucose in people with type 2 diabetes, was found to significantly reduce the risk of cardiovascular (heart-related death) and the risk of hospitalization for heart failure in people with or without diabetes.
The trial (called EMPEROR-Reduced) included 3,730 people with heart failure with reduced ejection fraction (HFrEF, or the ability to pump blood out of the heart), half of them with diabetes. People with diabetes have an increased risk of death and hospitalization with any type of heart failure. Participants in the trial were randomly assigned to receive either once-daily Jardiance or a placebo pill (containing no medication) for about 16 months.
Importantly, heart failure with preserved ejection fraction (HFpEF) – when the heart pumps sufficiently but has trouble filling with blood – affects people with diabetes more frequently than HFrEF; a study of Jardiance in people with HFpEF (called EMPEROR-Preserved) is still underway.
The trial met all three of the researchers’ goals. When compared to the control (placebo) group, people taking Jardiance showed:
A 25% reduced risk of cardiovascular death or first hospitalization for heart failure, whether or not they had diabetes
A 30% reduced risk in total number of recurrent heart failure hospitalizations
A slower decline of kidney function, measured by eGFR – learn about kidney disease, diabetes, and the importance of eGFR here
A 50% relative risk reduction for worsening kidney health measurements, indicating a decline in kidney function (including chronic dialysis, kidney transplant, and eGFR reduction)
Higher self-reported quality of life
These results show that Jardiance protects the heart and kidneys, similarly to Farxiga, another SGLT-2 inhibitor. The combination of this trial and the Farxiga heart trial (DAPA-HF) shows that SGLT-2s can now be considered a “cornerstone” of heart care for people with and without diabetes, as Dr. Packer expressed.
Farxiga Reduces Risk for People with Chronic Kidney Disease and Cardiovascular Problems in the DAPA-CKD Trial
On the second day of the conference, Professor Hiddo Heerspkink from The University Medical Center Groningen shared results on the kidney benefits of Farxiga. Farxiga, another SGLT2 inhibitor mentioned above and traditionally used to lower glucose in people with type 2 diabetes, was found to significantly improve kidney health in people with chronic kidney disease (CKD), with or without diabetes.
The trial included 4,304 participants with kidney disease (with or without diabetes, though people with type 1 diabetes were not included). People were randomly assigned to the treatment group, receiving once-daily Farxiga, or to the control group, receiving a placebo. About 67% of people in each group had type 2 diabetes, and they were followed for more than two years.
Results were extremely positive. The DAPA-CKD trial was stopped early in March of 2020 because the study monitoring committee found Farxiga to be overwhelmingly effective for preventing CKD from getting worse. Results now show that compared to the control group, people given Farxiga experienced:
A 39% relative risk reduction for overall decline in kidney health measurements (including eGFR decline, end stage kidney disease, and kidney-related or heart-related death), for people with or without type 2 diabetes
A 34% reduced combined risk of chronic dialysis, kidney transplantation, or kidney death
A 29% reduced risk of heart-related death or heart failure
A 31% relative risk reduction of all-cause mortality
Farxiga’s 31% reduced risk of all-cause mortality makes it the first medication to show a significant survival benefit for people with CKD with or without diabetes – though other SGLT-2 inhibitor trials have not necessarily shown the same benefit. However, the trial results are consistent with results from other major kidney trials such as CANVAS, EMPA-REG, and CREDENCE. Of note, DAPA-CKD is the first trial to demonstrate kidney disease treatment benefits of a SGLT-2 drug in people both with and without diabetes.
These therapies are very helpful for treating type 2 diabetes, including by lowering A1C, increasing time in range, reducing hypoglycemia, supporting weight loss, and (!) reducing the risk of heart and kidney diseases. Given the new trial results, we recommend that people with prediabetes (or type 2 diabetes) ask their doctor if they might benefit from one of these medications. We also want to point out that Farxiga is approved for people with type 1 diabetes in Europe and Japan – we are hopeful that clinical trials of SGLT-2s will show similar significant reductions in risk for people with type 1 diabetes.