New-onset erythrocytosis was associated with increased risk of coronary artery disease and stroke in adults with type 2 diabetes (T2D). Data presented at the European Association for the Study of Diabetes (EASD) 2025 highlight the cardiovascular implications of erythrocytosis during sodium-glucose cotransporter-2 (SGLT-2) inhibitor therapy.

This retrospective nationwide cohort study included 691,104 United States Veterans with T2D who had normal baseline hematocrit and no prior cardiovascular disease. Patients were classified as new SGLT-2 inhibitor users or controls. During one-year follow-up, erythrocytosis, defined as hematocrit ≥50%, occurred five times more frequently in SGLT-2 inhibitor users (10.6% vs 2.3%). In adjusted analyses, new-onset erythrocytosis was linked to a higher probability of incident coronary artery disease in both control and SGLT-2 inhibitor groups. Risk of stroke was elevated among control patients with erythrocytosis, while SGLT-2 inhibitor therapy did not significantly alter stroke risk.

These findings underscore the importance of monitoring hematocrit trends in adults with T2D initiating SGLT-2 inhibitor therapy. Early identification and management of erythrocytosis may reduce the risk of coronary artery disease.