LAUSR

Background: The cardiovascular and renal benefits of sodium glucose co-transporter 2 inhibitors (SGLT2i) have been clearly demonstrated. However, studies comparing the effects of dapagliflozin and empagliflozin are scarce. Therefore, we aimed to compare the clinical outcomes between dapagliflozin and empagliflozin in patients with type 2 diabetes without prior atherosclerotic cardiovascular disease, chronic kidney disease, or heart failure. Methods: Using a propensity-score matching method, we retrospectively analyzed 921 patients treated with dapagliflozin, 921 patients treated with empagliflozin, and 1842 patients treated with dipeptidyl peptidase-4 inhibitors (DPP4i; control group). Study outcomes comprised composite coronary events (acute coronary syndrome and coronary revascularization), composite ischemic events (coronary events and stroke), and composite heart failure and renal events. Results: During follow up (median, 43.4 months), the incidence of composite coronary events was significantly lower in the SGLT2i groups than in the control group, and the incidence of composite ischemic events was lower in the dapagliflozin group than in the control group. Dapagliflozin and empagliflozin both demonstrated significant benefits in terms of heart failure and renal outcomes, supported by renoprotective effects, as assessed by the change in glomerular filtration rate. At 24-36 months of treatment, the empagliflozin group had higher low-density lipoprotein cholesterol levels, and lower glycated hemoglobin levels, compared to those in the dapagliflozin and control groups. Conclusion : SGLT2i use was associated with a significantly reduced risk of atherosclerotic cardiovascular events, heart failure hospitalization, and renal events, compared to that with DPP4i use. There were no significant differences in clinical outcomes between dapagliflozin and empagliflozin, supporting a SGLT2i class effect.