Black vs White, this variation in race, ethnicity including etiology, and response to treatment has led to suspicion that black patients may respond to dapagliflozin (DAPA) differently than white patients. The efficacy of DAPA was tested and reported with patients having comorbidities such as heart failure with reduced ejection fraction. Several studies have highlighted the decreased risk of cardiovascular disease with SGLT2 therapy but the same result cannot be ascertained in the black population. Similarly, SGLT2 inhibitor therapy has a valuable effect in patients with reduced ejection fraction irrespective of type 2 diabetes.

Of the 4,744 patients randomized controlled in the DAPA-HF clinical trial conducted in America,31.5% i.e., 1,495 patients were enrolledout of which 1,181 (79.0%) were White, and 225 (15.1%) were Black. In the results published in 2022, Black patients had a higher rate of worsening HF events, but not mortality than White patients. When compared with placebo, dapagliflozin lowered the risk of the primary endpoint similarly in Black patients (HR: 0.62) and White patients (HR: 0.68). Consonant results were observed for other prespecified outcomes, including the composite of total (first and repeat) HF hospitalizations and cardiovascular death (P-interaction = 0.43). Also, the effect of study drug discontinuation and serious adverse events as prespecifiedbefore treatment were not significantly different in the randomized assignment of black and white patients. Consequently, DAPA improved the cardiovascular symptoms in both Black and White patients by lowering the risk of heart failure, Cardiovascular deaths, and,myocardialinfractions with no other significant adverse event. However, the adverse event and effects of drug discontinuation were more frequent in the placebo group than the dapagliflozin group in either Black or White patients.

These findings further cement the use of Dapagliflozin (DAPA) as a new treatment method for reduced ejection rate, and heart failure regardless of race and ethnicity.

Docherty K.F., et al., JACC Heart Fail, 2022, 10(1)