A post hoc analysis of the DECLARE-TIMI 58 trial found that dapagliflozin significantly reduced major adverse cardiovascular events (MACEs) and the composite of CV death and heart failure hospitalizations in type 2 diabetes (T2D) patients at high risk for advanced liver fibrosis. Patients with the highest FIB-4 scores saw the greatest benefit, with a 39% reduction in MACEs and a 50% reduction in the CV death/HF composite. The findings spotlight FIB-4 scoring as a useful tool for identifying high-risk T2D patients.
A post hoc analysis of the landmark DECLARE-TIMI 58 trial reveals that dapagliflozin, an SGLT2 inhibitor, offers meaningful cardiovascular protection for type 2 diabetes (T2D) patients who are at high risk for advanced liver fibrosis — a group that faces disproportionately elevated heart disease risk. Researchers stratified over 16,000 T2D patients by their fibrosis-4 (FIB-4) score and tracked cardiovascular outcomes over a median follow-up of 4.2 years.
The results were striking in the high-risk FIB-4 group (score ≥ 2.67): dapagliflozin cut the risk of major adverse cardiovascular events (MACEs) by 39% and slashed the composite of CV death and heart failure hospitalization by 50% compared to placebo. The drug also reduced liver enzyme levels (AST and ALT) in this group during the first year of treatment, with no hepatic events attributed to its use.
By the Numbers:
Why it matters: As obesity and T2D drive rising rates of liver fibrosis, identifying which patients face the highest cardiovascular risk is critical. This study positions FIB-4 scoring as a practical, accessible tool for risk stratification, and reinforces dapagliflozin's role as a cardioprotective therapy — particularly for the highest-risk patients who stand to benefit the most.
