The sodium glucose cotransporter-2 (SGLT-2) inhibitor canagliflozin is associated with a reduced risk of cardiovascular death or hospitalization from heart failure for patients with type 2 diabetes who have an elevated risk of cardiovascular disease, according to the results of the CANVAS trial presented by Gemma Figtree, MBBS, DPhil, in a Featured Clinical Research session on Sunday, March 11 at ACC.18 in Orlando, FL., and simultaneously published in Circulation.

CANVAS enrolled 10,142 participants with type 2 diabetes and high cardiovascular risk. They were randomly assigned to canagliflozin or placebo and followed for a mean of 188 weeks. The primary endpoint – adjudicated cardiovascular death or hospitalization for heart failure – was reduced in those treated with canagliflozin compared with placebo (16.3 vs. 20.8 per 1000 patient-years), for a 22 percent reduction. No difference was seen for the primary outcome in relation to the dose, with an 18 percent reduction for both the 100 mg and 300 mg dose.

The results suggest that the benefit for the primary outcome may be greater in patients with a history of heart failure at baseline, a group that experienced a 39 percent reduction compared with the 13 percent reduction in those without heart failure (p for interaction = 0.021). In the patients who had a history of heart failure and use of loop diuretic, there as a 46 percent reduction in the primary outcome.

Likewise, there was a 30 percent reduction in fatal or hospitalized heart failure and a 33 percent reduction in hospitalization for heart failure. A broad range of participant subgroups all benefited from an SGLT-2 inhibitor, including those using established treatments for the prevention of heart failure.

According to the researchers, the results provide evidence of the protective effect of canagliflozin in heart failure and suggest a role for SGLT-2 inhibitors in the prevention of heart failure for type 2 diabetes patients. Additional data from ongoing diabetes trials will further clarify this role.

Keywords: ACC18, ACC Annual Scientific Session, Heart Failure, Diabetes Mellitus, Type 2, Diuretics, Cardiovascular Diseases, Risk Factors, Adrenergic beta-Antagonists, Hospitalization, Myocardial Infarction, Glucose, Symporters, Sodium

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