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SGLT2 Inhibitors vs. GLP-1 Receptor Agonists in Patients With and Without CVD
Quick Takes
- Initiating SGLT2 inhibitor versus GLP-1 receptor agonist (RA) therapy was associated with no differences in the risk for the primary outcome of hospitalization for MI or stroke.
- SGLT2 inhibitor versus GLP-1 RA therapy was associated with an approximately 30% reduction in the risk for the primary hospitalization for heart failure outcome irrespective of presence or absence of CVD at baseline.
- These real-world clinical data support current guidelines, which suggest that SGLT2 inhibitors and GLP-1 RAs offer similar benefits in atherosclerotic CVD prevention to patients with T2D, and that SGLT2 inhibitors offer greater efficacy in reducing hospitalization for heart failure.
Study Questions:
What are the cardiovascular (CV) benefits with sodium-glucose cotransporter-2 (SGLT2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) among type 2 diabetes (T2D) patients with and without CV disease (CVD), and what is the potential differential CV benefit of these agents?
Methods:
The investigators conducted a population-based cohort study using Medicare and two US commercial claims data sets from April 2013–December 2017. 1:1 propensity score-matched adult T2D patients with and without CVD (52,901 and 133,139 matched pairs) initiating SGLT2 inhibitor versus GLP-1 RA therapy were included in the analysis. Primary outcomes were myocardial infarction (MI) or stroke hospitalization and hospitalization for heart failure (HHF). Pooled hazard ratios (HRs) and rate differences (RDs) per 1,000 person-years were estimated, with 95% confidence intervals (CIs), controlling for 138 pre-exposure covariates.
Results:
The initiation of SGLT2 inhibitor versus GLP-1 RA therapy was associated with a slightly lower risk for MI or stroke in patients with CVD (HR, 0.90 [95% CI, 0.82-0.98]; RD, -2.47 [CI, -4.45 to -0.50]) but similar risk in those without CVD (HR, 1.07 [CI, 0.97-1.18]; RD, 0.38 [CI, -0.30 to 1.07]). The initiation of SGLT2 inhibitor versus GLP-1 RA therapy was associated with reductions in HHF risk regardless of baseline CVD in patients with CVD (HR, 0.71 [CI, 0.64-0.79]; RD, -4.97 [CI, -6.55 to -3.39]) and in those without CVD (HR, 0.69 [CI, 0.56-0.85]; RD, -0.58 [CI, -0.91 to -0.25]).
Conclusions:
The authors concluded that use of SGLT2 inhibitors versus GLP-1 RAs was associated with consistent reductions in HHF risk among T2D patients with and without CVD, although the absolute benefit was greater in patients with CVD.
Perspective:
This population-based study reports that initiating SGLT2 inhibitor versus GLP-1 RA therapy was associated with no differences in the risk for the primary outcome of hospitalization for MI or stroke. However, the initiation of SGLT2 inhibitor versus GLP-1 RA therapy was associated with an approximately 30% reduction in the risk for the primary HHF outcome in all included patients, regardless of the presence or absence of CVD at baseline. Overall, these real-world clinical data support current guidelines, which suggest that SGLT2 inhibitors and GLP-1 RAs offer similar benefits in atherosclerotic CVD prevention to patients with T2D, and that SGLT2 inhibitors offer greater efficacy in reducing HHF.
Clinical Topics: Acute Coronary Syndromes, Dyslipidemia, Heart Failure and Cardiomyopathies, Prevention, Lipid Metabolism, Acute Heart Failure
Keywords: Acute Coronary Syndrome, Atherosclerosis, Cardiometabolic Risk Factors, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Glucagon-Like Peptide 1, Glucagon-Like Peptide-1 Receptor, Heart Failure, Hospitalization, Myocardial Infarction, Myocardial Ischemia, Primary Prevention, Sodium-Glucose Transporter 2 Inhibitors, Sodium-Glucose Transporter 2, Stroke, Vascular Diseases
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