- 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.
- 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.
- 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).
- Confounding by indication.