Improved Cardiovascular and Renal Outcomes in the CANagliflozin CardioVascular Assessment Study (CANVAS) Program Irrespective of Baseline (BL) Body Mass Index (BMI)


Overweight and obesity increases the risk of heart and kidney disease. The effects of canagliflozin (CANA) in patients with BL BMI <30 or ≥30 kg/m2 was a prespecified analysis in the CANVAS Program. CANA reduced CV and renal outcomes in patients with T2D and high CV risk (N = 10,142). At BL compared to patients with BMI <30 kg/m2, more patients with BMI ≥30 kg/m2 had SBP ≥140 or DBP ≥90 mmHg (47.9% vs. 40.3%) and were taking RAAS inhibitors (83.8% vs. 74.6%). Effects of CANA on the primary outcome (CV death, nonfatal myocardial infarction, or nonfatal stroke) and other CV outcomes were consistent between BMI subgroups (Fig). CANA decreased progression of albuminuria in both BMI subgroups with the effect appearing greater in patients with BMI ≥30 kg/m2. Further statistical testing did not show a qualitative interaction (Gail-Simons P = 0.875). The comparative benefits of CANA on albuminuria in patients with higher BMI may be due to greater reductions in body weight (placebo-subtracted difference at 1 y: -2.1 and -2.8 kg for BMI <30 and ≥30 kg/m2) and BP (SBP: -4.2 and -4.6 mmHg; DBP: -1.0 and -1.7 mmHg for BMI <30 and ≥30 kg/m2); HbA1c reductions were similar with BMI <30 and ≥30 kg/m2 (-0.60% and -0.63%). While small statistical heterogeneity may exist, BMI <30 vs. ≥30 kg/m2 does not appear to be a major determinant of the observed improvements in CV outcomes with CANA.

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