TY - JOUR
T1 - Effect of Canagliflozin on Heart Failure Hospitalization in Diabetes According to Baseline Heart Failure Risk
AU - Khan, Muhammad Shahzeb
AU - Segar, Matthew W.
AU - Usman, Muhammad Shariq
AU - Patel, Kershaw V.
AU - Van Spall, Harriette G.C.
AU - DeVore, Adam D.
AU - Vaduganathan, Muthiah
AU - Lam, Carolyn S.P.
AU - Zannad, Faiez
AU - Verma, Subodh
AU - Butler, Javed
AU - Tang, W. H.Wilson
AU - Pandey, Ambarish
N1 - Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
PY - 2023/7
Y1 - 2023/7
N2 - BACKGROUND: In the CANVAS (Canagliflozin Cardiovascular Assessment Study) program, canagliflozin reduced the risk of heart failure (HF) hospitalization among individuals with type 2 diabetes mellitus (T2DM).OBJECTIVES: The purpose of this study was to evaluate heterogeneity in absolute and relative treatment effects of canagliflozin on HF hospitalization according to baseline HF risk as assessed by diabetes-specific HF risk scores (WATCH-DM [Weight (body mass index), Age, hyperTension, Creatinine, HDL-C, Diabetes control (fasting plasma glucose) and QRS Duration, MI and CABG] and TRS-HF
DM [TIMI Risk Score for HF in Diabetes]).
METHODS: Participants in the CANVAS trial were categorized into low, medium, and high risk for HF using the WATCH-DM score (for participants without prevalent HF) and the TRS-HF
DM score (for all participants). The outcome of interest was time to first HF hospitalization. The treatment effect of canagliflozin vs placebo for HF hospitalization was compared across risk strata.
RESULTS: Among 10,137 participants with available HF data, 1,446 (14.3%) had HF at baseline. Among participants without baseline HF, WATCH-DM risk category did not modify the treatment effect of canagliflozin (vs placebo) on HF hospitalization (P interaction = 0.56). However, the absolute and relative risk reduction with canagliflozin was numerically greater in the high-risk group (cumulative incidence, canagliflozin vs placebo: 8.1% vs 12.7%; HR: 0.62 [95% CI: 0.37-0.93]; P = 0.03; number needed to treat: 22) than in the low- and intermediate-risk groups. When overall study participants were categorized according to the TRS-HF
DM score, a statistically significant difference in the treatment effect of canagliflozin across risk strata was observed (P interaction = 0.04). Canagliflozin significantly reduced the risk of HF hospitalization by 39% in the high-risk group (HR: 0.61 [95% CI: 0.48-0.78]; P < 0.001; number needed to treat: 20) but not in the intermediate- or low-risk groups.
CONCLUSIONS: Among participants with T2DM, the WATCH-DM and TRS-HF
DM can reliably identify those at high risk for HF hospitalization and most likely to benefit from canagliflozin.
AB - BACKGROUND: In the CANVAS (Canagliflozin Cardiovascular Assessment Study) program, canagliflozin reduced the risk of heart failure (HF) hospitalization among individuals with type 2 diabetes mellitus (T2DM).OBJECTIVES: The purpose of this study was to evaluate heterogeneity in absolute and relative treatment effects of canagliflozin on HF hospitalization according to baseline HF risk as assessed by diabetes-specific HF risk scores (WATCH-DM [Weight (body mass index), Age, hyperTension, Creatinine, HDL-C, Diabetes control (fasting plasma glucose) and QRS Duration, MI and CABG] and TRS-HF
DM [TIMI Risk Score for HF in Diabetes]).
METHODS: Participants in the CANVAS trial were categorized into low, medium, and high risk for HF using the WATCH-DM score (for participants without prevalent HF) and the TRS-HF
DM score (for all participants). The outcome of interest was time to first HF hospitalization. The treatment effect of canagliflozin vs placebo for HF hospitalization was compared across risk strata.
RESULTS: Among 10,137 participants with available HF data, 1,446 (14.3%) had HF at baseline. Among participants without baseline HF, WATCH-DM risk category did not modify the treatment effect of canagliflozin (vs placebo) on HF hospitalization (P interaction = 0.56). However, the absolute and relative risk reduction with canagliflozin was numerically greater in the high-risk group (cumulative incidence, canagliflozin vs placebo: 8.1% vs 12.7%; HR: 0.62 [95% CI: 0.37-0.93]; P = 0.03; number needed to treat: 22) than in the low- and intermediate-risk groups. When overall study participants were categorized according to the TRS-HF
DM score, a statistically significant difference in the treatment effect of canagliflozin across risk strata was observed (P interaction = 0.04). Canagliflozin significantly reduced the risk of HF hospitalization by 39% in the high-risk group (HR: 0.61 [95% CI: 0.48-0.78]; P < 0.001; number needed to treat: 20) but not in the intermediate- or low-risk groups.
CONCLUSIONS: Among participants with T2DM, the WATCH-DM and TRS-HF
DM can reliably identify those at high risk for HF hospitalization and most likely to benefit from canagliflozin.
KW - TRS-HF
KW - WATCH-DM
KW - diabetes
KW - heart failure
KW - risk scores
KW - Heart Failure/drug therapy
KW - Canagliflozin/therapeutic use
KW - Humans
KW - Hospitalization
KW - Sodium-Glucose Transporter 2 Inhibitors/therapeutic use
KW - Diabetes Mellitus, Type 2/complications
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U2 - 10.1016/j.jchf.2023.03.025
DO - 10.1016/j.jchf.2023.03.025
M3 - Article
C2 - 37227388
AN - SCOPUS:85162188858
SN - 2213-1779
VL - 11
SP - 825
EP - 835
JO - JACC: Heart Failure
JF - JACC: Heart Failure
IS - 7
ER -