Heterogeneous cardiovascular effects of sodium-glucose cotransporter 2 inhibitors in type 2 diabetes: a causal forest and target trial emulation study
Main findingResult — go to the result3-year risk difference +0.38 percentage points 95% CI 0.16–0.61Authors' conclusion
The cardioprotective effect of SGLT2i was heterogeneous and more strongly predicted by individual patient characteristics than by overall CVD risk score
Study context
- Population
- Working-age Japanese people with T2DM, 2015–23mean age 54 years
- Participants
- 150,830 people
- Exposure
- SGLT2 inhibitors vs DPP4 inhibitors
- Outcome
- Composite of:
- All-cause death
- MI
- Stroke
- HF
- Follow-up
- 3 years
Methodological detailsnationwide insurer-based database
- Nationwide insurer-based database
Main finding
As reported in the abstract
3-year risk difference
+0.38 percentage points
95% CI 0.16–0.61
Observational data: associations, not effects.
Further findings
Heterogeneity of predicted benefit (causal forest) vs cardiovascular disease (CVD) risk score
- Estimated benefit correlated weakly with CVD risk score (r)
- 0.287, P < 0.001
Predicted benefit among individuals with low CVD risk (subgroup)
- Predicted to benefit from SGLT2i, of 107 425 with low CVD risk
- 97 757 (91.0%)
- Characterized by higher BP, BMI and fasting plasma glucose despite low CVD risk score
Original publication
Heterogeneous cardiovascular effects of sodium-glucose cotransporter 2 inhibitors in type 2 diabetes: a causal forest and target trial emulation study. Eur J Prev Cardiol. Published 1 September 2025. doi:10.
Summarised from the published abstract; every number is checked against it