Association SGLT2 Inhibitor Use and Cardiovascular Health Among Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Analysis of NHANES Data

Abstract

Background: Sodium-glucose cotransporter 2 (SGLT2) inhibitors improve cardiovascular and kidney outcomes in randomized trials, but their early use and the cardiovascular profile of users in the United States population remain less clearly described.
Methods: This cross-sectional study examined current SGLT2 inhibitor use and cardiovascular health among medication-treated adults with type 2 diabetes mellitus using National Health and Nutrition Examination Survey data from 2013 to 2018. Prescription records identified current use. The primary outcome was self-reported cardiovascular disease, defined as a history of congestive heart failure, coronary heart disease, angina, myocardial infarction, or stroke. Survey-weighted logistic and linear regression incorporated the complex sampling design and adjusted for demographic and clinical covariates.
Results: Among 1,978 eligible participants, 57 used an SGLT2 inhibitor. Weighted use increased from 0.5% in 2013 to 2014 to 7.1% in 2017 to 2018 and was 3.7% across the pooled period. Users were younger, had shorter diabetes duration, and had higher estimated glomerular filtration rate than nonusers. Weighted cardiovascular disease prevalence was 34.1% among users and 28.3% among nonusers. The fully adjusted odds ratio was 1.66 (95% confidence interval, 0.72 to 3.87; p = .231). Adjusted differences in blood pressure, body mass index, glycated hemoglobin, and lipid measures were imprecise, and sensitivity analyses did not materially alter the primary estimate.
Conclusion: SGLT2 inhibitor uptake increased substantially during early adoption. The findings characterize prescribing patterns and prevalent health profiles rather than causal treatment effects because medication use and cardiovascular history were measured concurrently.