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Hidekazu Kondo, Naohiko Takahashi, Reduced hospitalization for heart failure using anti-diabetic drug dapagliflozin: implications of DECLARE–TIMI 58 for the basic science community, Cardiovascular Research, Volume 115, Issue 6, 01 May 2019, Pages e54–e57, https://doi.org/10.1093/cvr/cvz073
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Sodium glucose cotransporter 2 (SGLT2) inhibitors are the anti-diabetic drugs that regulate plasma glucose levels by inhibiting reabsorption of glucose and sodium in the proximal tubules of the kidney. Empagliflozin and canagliflozin demonstrated a reduction in a composite of major adverse cardiovascular events (MACE; cardiovascular death, myocardial infarction, or ischaemic stroke), hospitalization for heart failure and renal events in patients with type 2 diabetes in EMPA-REG OUTCOME1 and CANVAS,2,3 respectively. It is of note that all the patients had established cardiovascular disease in EMPA-REG OUTCOME,1 and that 64.8% of the patients had a history of cardiovascular disease in CANVAS,2,3 indicating that these two SGLT2 inhibitors have shown a favourable cardiovascular effect, predominantly in patients with established cardiovascular disease. In fact, in the subgroup analysis of CANVAS,2 the significantly improved primary cardiovascular outcome observed in patients with a history of cardiovascular disease was not evident in those without.2 In this regard, DECLARE–TIMI 58 is of worth because it evaluated the effects of dapagliflozin, another SGLT2 inhibitor, in a ‘broad’ population of type 2 diabetic patients.4