Sudden cardiac death (SCD) is at the first rank of cardiovascular death causes in patients with type 2 diabetes (T2D). ACEIs and statins, but not antidiabetic agents were known to be effective in preventing this accident in these patients, until the EMPAREG OUTCOME trial. This study reported a significant protective effect on SCD by empagliflozin, a hypoglycemic drug inhibiting sodium–glucose cotransporter.Objective:
We aimed here to estimate the public health impact of this tri-therapy in preventing SCD in a French type 2 diabetic virtual realistic population (VRP).Design and method:
The steps of our approach were (i) developing a refined scoring scheme for calculating the risk of SCD in T2D, using logistic regression model on individual data of 21 036 men and 9 524 women (age ranged from 35 to 98 years) from 7 RCTs (INDANA database and DIABHYCAR trial); (ii) estimating the risk reduction on SCD in T2D by ACEI and statin through existing meta-analyses and by gliflozin from EMPAREG OUTCOME trial; and finally (iii) integrating the results obtained on a VRP generated from real French cohorts with risk-based patient selection and different therapeutic strategies.Results:
A French diabetic RVP of 176 187 was generated from a 8 995-patient sample, giving median of SCD risk of 1.7% at a 5-year time horizon. A simulation of public health impact in this platform estimated the numbers needed to treat (NNTs) of 110 people when whole population was treated and of 52 people when treatment was focused in 10% of patients with highest estimated SCD risk, simultaneously by statin, ACEI and empagliflozin for one year (Tab 1).Conclusions:
Our results suggested that the largest strategy by this tri-therapy would prevent 1 SCD every year among 110 patients at possible SCD risk. However, interaction between concerned drugs should be further verified. On the other hand, we confirmed here the feasibility of our approach to simulate impact of various drugs strategies. This could be an innovative tool to base public health strategies and help individual decision-making.