This past autumn I was invited to give a lecture at the Michigan ACP. I love that meeting. I decided to talk about the mortality data on SGLT2 inhibitors and how we got that data and how curious that data is. Then, last week I had the opportunity to give the lecture again for grand rounds at St John Hospital and Medical Center. Here it is in 4 chapters:
Chapter 1: The History and top line CV outcomes
Chapter 2: What’s driving the improvement in outcomes?
Chapter 3: Renal outcomes
Chapter 4: Side effects and conclusions
Here is the Keynote presentation for your editing pleasure: Keynote (278 mb)
In response to chapter 2, Matt Sparks had this interesting tweet:
Don’t worry. We are still trying to figure out the renin angiotensin (aldo) system #Research #NeverEnding
— Matthew Sparks, MD (@Nephro_Sparks) December 15, 2017
This brings up an important point. One of the most intriguing slides is the one below that looks at how long it takes for the Kaplan-Meier to separate.
With glycemic control and blood pressure interventions, their is notable lag, but with the SGLT2i drugs the lines diverge from the very first dose. We also see that pattern with ACEi in heart failure and aldosterone antagonists in heart failure. This may be a clue of where to look for the cause of the survival advantage.
RALES (3 months)
CONSENSUS (first dose)
I will be adding this slide to the next version of the talk.