Abstract 4346854: Intensive Blood Pressure Control and SGLT2 Inhibitors for the PREVENTion of Heart Failure: The Multi-Ethnic Study of Atherosclerosis

Abstract

Background: Intensive systolic blood pressure (SBP) lowering and sodium-glucose cotransport-2 inhibitor (SGLT2i) treatment can reduce the risk of incident heart failure (HF). Research Question: Based on the American Heart Association Predicting Risk of Cardiovascular Disease Events (PREVENT) estimated risk, what is the modeled number needed to treat (NNT) to a SBP <120 mmHg or with a SGLT2i to prevent an incident diagnosis of HF? Goal: Estimate the 5-year number needed to treat (NNT 5 ) to prevent one HF event for intensive systolic blood pressure control and SGLT2i initiation according to PREVENT HF risk. Methods: Baseline (2000-02) data for 6,034 participants in the Multi-Ethnic Study of Atherosclerosis (MESA) were used to calculate PREVENT HF risk. Mean risk reduction estimates from randomized controlled trials targeting SBP <120 mmHg [38% relative risk reduction (RRR)] and with SGLT2i (31% RRR) were applied to observed HF incidence rates in MESA for NNT 5 calculations across baseline HF risk, as well as N-terminal prohormone of brain natriuretic peptide (NT-proBNP), and diabetes related risk. Low, intermediate, and high 10-year HF risk were defined as <5%, 5-14%, and > 15%, respectively. Results: Mean age was 62 years, 53% were female, 61% were non-white, and 12% had diabetes. The median 10-year PREVENT HF risk was 4%, distributed across individuals with low (52%), intermediate (39%), and high risk (9%). Over 10-year follow-up, there were 198 incident HF cases (3.6 per 1,000 person-years). In the overall sample, the estimated NNT 5 was 112 for intensive SBP control and 199 for SGLT2i. There were large differences in NNT 5 for intensive SBP control and SGLT2i among individuals with low PREVENT HF risk (537 and 768) versus high PREVENT HF risk (34 and 45) ( Figure ). Among individuals with an intermediate PREVENT HF risk, those with NT-proBNP > 125 pg/mL or diabetes had a lower NNT 5 for intensive SBP control (47 and 53) and SGLT2i (64 and 91) compared to those with NT-proBNP <125 pg/mL or without diabetes (intensive SBP control: 209 and 137; SGLT2i: 310 and 183). Conclusions: Both intensive SBP control and SGLT2i had a stepwise lower NNT 5 to prevent the incident diagnosis of HF across higher PREVENT risk scores, with a lower NNT 5 for intensive SBP control compared to SGLT2i. Incorporation of NTproBNP and DM assessment among intermediate risk persons may further guide allocation of therapies to reduce the risk of HF.