Comparison of GLP-1 receptor agonists and other Glucose-Lowering agents on cardiovascular outcomes in individuals with type 2 diabetes and Obesity: A Spanish Real-World Population-Based study

• Published in: Diabetes research and clinical practice 2024-01, Vol.207, p.111071-111071, Article 111071
• Main Authors: Palanca, Ana, Ampudia-Blasco, F. Javier, Calderón, José Miguel, Sauri, Inmaculada, Martinez-Hervás, Sergio, Trillo, José Luis, Redón, Josep, Real, José T.
• Format: Article
• Language: English
• Subjects: Adult; Atrial Fibrillation; Cardiovascular Diseases - chemically induced; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - prevention & control; Cardiovascular risk; Diabetes Mellitus, Type 2; Glucagon-Like Peptide-1 Receptor - agonists; Glucagon-like peptide-1 receptor agonists (GLP-1RA); Glucose; Glucose-lowering agents; Heart Failure - chemically induced; Humans; Hypoglycemic Agents - therapeutic use; Insulin - therapeutic use; Obesity - complications; Obesity - drug therapy; Obesity - epidemiology; Real-world study; Retrospective Studies; Sodium-Glucose Transporter 2 Inhibitors - therapeutic use; Type 2 diabetes
• ISSN: 0168-8227; 1872-8227
• DOI: 10.1016/j.diabres.2023.111071

Assess the impact of glucagon-like peptide receptor agonists (GLP-1RA) compared to other glucose-lowering agents on cardiovascular outcomes in individuals with type 2 diabetes and obesity in a Spanish metropolitan area. A retrospective population-based type 2 diabetes cohort was identified from the Valencia Clinic-Malvarrosa Department electronic databases (2014–2019). Study groups included GLP-1RA, sodium-glucose co-transporter-2 inhibitors (SGLT2i), Insulin, and Miscellany (other glucose-lowering agents). 1:1:1:1 propensity score matching was conducted. The primary outcome was a composite of major adverse cardiovascular events (4-point MACE) comprising myocardial infarction, stroke, all-cause mortality, and heart failure. Secondary outcomes included individual 4-point MACE components. Hazard ratios were estimated using Cox regression analyses against the Miscellany group. From 26,944 subjects, 1,848 adults were selected per group. GLP-1RA did not show a significant reduction in 4-point MACE risk (HR 1.05 [95%CI 0.82–1.34]). SGLT2i significantly reduced the risk of heart failure (HR 0.16 [95%CI 0.05–0.54]) and atrial fibrillation (HR 0.58, [95%CI 0.35–0.95]). The Insulin group exhibited a higher risk for 4-point MACE and most individual outcomes compared to GLP-1RA and SGLT2i. Our findings do not provide evidence of a reduced cardiovascular risk, as assessed by 4-point MACE, with GLP-1RA. In contrast, SGLT2i demonstrated protective effects against heart failure and atrial fibrillation.