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Review
. 2025 May 4;17(5):e83449.
doi: 10.7759/cureus.83449. eCollection 2025 May.

Comparative Cardiovascular Outcomes of Dapagliflozin Versus Empagliflozin in Patients With Type 2 Diabetes: A Meta-Analysis

Rhuna Dhana  1 , Yousef Aqel  2 , Anurag Rawat  3 , Aakash Mahato  4 , Abdelaziz Maali Abusal  5 , Nazish Munawar  6 , Calvin R Wei  7 , Adil Amin  8
Affiliations
Review

Comparative Cardiovascular Outcomes of Dapagliflozin Versus Empagliflozin in Patients With Type 2 Diabetes: A Meta-Analysis

Rhuna Dhana et al. Cureus. .

Abstract

Sodium-glucose co-transporter-2 (SGLT2) inhibitors have demonstrated significant cardiovascular benefits in patients with type 2 diabetes. However, head-to-head comparisons between dapagliflozin and empagliflozin, two widely prescribed SGLT2 inhibitors, remain limited. This meta-analysis aimed to directly compare the cardiovascular outcomes of these agents in patients with type 2 diabetes. We conducted a comprehensive literature search across multiple databases and included eight retrospective studies enrolling 280,617 patients (158,352 receiving empagliflozin and 122,265 receiving dapagliflozin). The primary outcome was major adverse cardiovascular events (MACE), with secondary outcomes including all-cause mortality, myocardial infarction, and stroke. Our pooled analysis revealed no significant difference in MACE risk between empagliflozin and dapagliflozin (RR: 1.04; 95% CI: 0.96 to 1.13). Similarly, no significant differences were observed for all-cause mortality (RR: 1.05; 95% CI: 0.96 to 1.15), myocardial infarction (RR: 1.04; 95% CI: 0.94 to 1.16), or stroke (RR: 1.00; 95% CI: 0.91 to 1.09). Subgroup analyses by gender, atherosclerotic cardiovascular disease, and chronic kidney disease status showed consistent results. However, in patients with heart failure, a trend toward reduced MACE risk was observed with empagliflozin (RR: 0.90; 95% CI: 0.82 to 1.00). Despite pharmacokinetic differences between these agents, our findings suggest comparable cardiovascular outcomes in patients with type 2 diabetes, with potentially enhanced benefits of empagliflozin in those with heart failure. However, due to lack of studies, this finding should be interpreted with caution. These results provide valuable insights for clinical decision-making when selecting SGLT2 inhibitors for cardiovascular risk reduction in diabetic patients. Further prospective studies are warranted to confirm these findings and explore potential mechanistic differences between these agents.

Keywords: cardiovascular outcomes; dapagliflozin; empagliflozin; sglt2 inhibitors; type 2 diabetes.

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Conflict of interest statement

Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. PRISMA flowchart (study selection process)
PRISMA - Preferred Reporting Items for Systematic reviews and Meta-Analyses
Figure 2
Figure 2. Comparison of MACE between two groups
MACE - major adverse cardiovascular events Sources: references [15-17, 19, 21]
Figure 3
Figure 3. Comparison of all-cause mortality between two groups
Sources: references [16-18]
Figure 4
Figure 4. Comparison of myocardial infarction between two groups
Sources: references [16-17, 19-22]
Figure 5
Figure 5. Comparison of stroke between two groups
Sources: references [16-19, 21-22]
See this image and copyright information in PMC

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