Article Impact Level: HIGH Data Quality: STRONG Summary of Annals of Internal Medicine, M22-2751. https://doi.org/10.7326/M22-2751 Dr. Tadarro Richardson Jr. et al.
Points
- A retrospective cohort study of U.S. veterans examined the effectiveness of GLP1RA and SGLT2i in preventing major adverse cardiac events (MACE) for individuals without preexisting cardiovascular disease.
- Adding GLP1RA was associated with a lower incidence of MACE and heart failure (HF) hospitalization than DPP4i, with an 18% reduced risk and 3.2 fewer events per 1000 person-years.
- However, SGLT2i did not significantly correlate with MACE prevention or HF hospitalization compared to DPP4i.
- The study cohort included over 28,000 weighted pairs of veterans adding GLP1RA and DPP4i and over 21,000 weighted pairs adding SGLT2i and DPP4i.
- The study highlights the potential benefits of GLP1RA as a primary prevention strategy for reducing MACE and HF in individuals without preexisting cardiovascular disease. At the same time, further research is needed to clarify the comparative effectiveness of these medications as first-line therapies.
Summary
This retrospective cohort study analyzed 28,759 weighted pairs of veterans who added GLP1RA onto metformin, sulfonylurea, or insulin treatment alone or in combination, compared with 28,628 weighted pairs who added DPP4i. Additionally, 21,200 veterans who added SGLT2i were compared with 21,170 weighted pairs who added DPP4i. The cohort’s median age was 67 years, with a diabetes duration of 8.5 years.
The study findings revealed that using GLP1RA was associated with a significantly lower incidence of MACE and HF hospitalization than DPP4i. The adjusted hazard ratio (aHR) for GLP1RA versus DPP4i was 0.82 (95% CI, 0.72 to 0.94), indicating an 18% lower risk of MACE and HF with GLP1RA use. This corresponded to an adjusted risk difference (aRD) of 3.2 events (CI, 1.1 to 5.0) per 1000 person-years.
In contrast, the addition of SGLT2i did not show a statistically significant association with MACE prevention or HF hospitalization compared to DPP4i. The aHR for SGLT2i versus DPP4i was 0.91 (CI, 0.78 to 1.08), suggesting a relative risk of MACE and HF between these two treatment groups. The adjusted risk difference (aRD) for SGLT2i was 1.28 events (-1.12 to 3.32) per 1000 person-years, indicating a relatively small effect size.
Despite the observed associations, it is essential to consider the limitations of this study, including potential residual confounding factors and the omission of examining DPP4i, GLP1RA, and SGLT2i as first-line therapies. Future research should address these limitations to further elucidate these medications’ comparative effectiveness and safety as primary prevention strategies for individuals without preexisting cardiovascular disease.
Link to the article: https://www.acpjournals.org/doi/10.7326/M22-2751
References Richardson, T. L., Halvorson, A. E., Hackstadt, A. J., Hung, A. M., Greevy, R., Grijalva, C. G., Elasy, T. A., & Roumie, C. L. (2023). Primary occurrence of cardiovascular events after adding sodium–glucose cotransporter-2 inhibitors or glucagon-like peptide-1 receptor agonists compared with dipeptidyl peptidase-4 inhibitors: A cohort study in veterans with diabetes. Annals of Internal Medicine, M22-2751. https://doi.org/10.7326/M22-2751
