Dapagliflozin and Cardiovascular Outcomes in Patients with Type 2 Diabetes and Prior Myocardial Infarction: A Sub-analysis From DECLARE TIMI-58 Trial

Background: Sodium glucose transporter-2 inhibitors (SGLT2i) reduce the risk of major adverse cardiovascular events (MACE) in patients with type 2 diabetes mellitus (T2DM) and a history of atherosclerotic cardiovascular (CV) disease (ASCVD). Because of their baseline risk, patients with prior myocardial infarction (MI) may derive even greater benefit from SGLT2i therapy. Methods: DECLARE TIMI-58 randomized 17,160 patients with T2DM and either established ASCVD (n = 6,974) or multiple risk factors (MRF) (n = 10,186) to dapagliflozin versus placebo. The two primary endpoints were composite of MACE (CV death, MI or ischemic stroke) and the composite of CV death or hospitalization for heart failure (HHF). Prior MI (n = 3,584) was a pre-specified subgroup of interest. Results: In patients with prior MI (n=3,584), dapagliflozin reduced the relative risk of MACE by 16% and the absolute risk by 2.6 % (15.2% vs. 17.8%; HR 0.84; 95%CI 0.72-0.99; p=0.039) whereas there was no effect in patients without prior MI (7.1...