Greater CVD benefit seen with SGLT2 inhibitors vs GLP-1RAs

  • Longato E & al.
  • BMJ Open Diabetes Res Care
  • 1 Jun 2020

  • curated by Miriam Tucker
  • Clinical Essentials
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Takeaway

  • Major adverse cardiovascular events (MACE) and hospitalization for heart failure are lower in patients with type 2 diabetes (T2D) initiating sodium-glucose cotransporter-2 inhibitors (SGLT2is) vs glucagon-like peptide-1 receptor agonists (GLP-1RAs).

Why this matters

  • Patients with T2D experience high MACE rates.
  • Both SGLT2is and GLP-1RAs reduce MACE, but no trial has compared them to determine which is more effective.

Study design

  • Retrospective real-world study in the Veneto region of Northeast Italy of 12,996 patients with T2D, initiating either a SGLT2i (n=7192) or GLP-1RA (n=5804) matched 1:1 by propensity scores.
  • Primary outcome was 3-point MACE (3P-MACE), a composite of all-cause death, myocardial infarction (MI), and stroke.
  • Funding: University of Padova, Italian Ministry for Education.

Key results

  • In median 13-month follow-up, incidence of 3P-MACE:
    • 21.8 events/1000 person-years with SGLT2is vs 
    • 27.9 events/1000 person-years with GLP-1RAs.
    • HR: 0.78 (P=.043).
  • With SGLT2is, lower risk (HRs) for:
    • MI: 0.72 (P=.035).
    • Heart failure hospitalization: 0.59 (P=.048). 
    • CVD hospitalization: 0.82 (P=.037).
  • Adverse events included 2 with diabetic ketoacidosis (1 per group), 16 amputations (10 SGLT2i vs 6 GLP-1RA), and 36 acute kidney injury (13 SGLT2i vs 23 GLP-1RA; P=.086).

Limitations

  • Retrospective.
  • Nonrandomized.
  • Confounding by indication.