- In patients with type 2 diabetes (T2D) and established atherosclerotic cardiovascular disease (ASCVD), glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT2is) reduce major adverse cardiovascular events (MACE) similarly.
- But SGLT2is hold the advantage in preventing hospitalization for heart failure (HF) and reducing estimated glomerular filtration rate (eGFR) in many patients.
Why this matters
- Few data are available comparing outcomes for the 2 drug classes.
- Systematic review, trial-level meta-analysis of 5 GLP-1RA and 3 SGLT2i cardiovascular outcome trials.
- MACE: composite of myocardial infarction, stroke, cardiovascular death.
- Funding: German Research Foundation, Harvard University/Brigham and Women's Hospital.
- Risk reductions (HRs; 95% CIs) in MACE:
- 12% for GLP-1RAs: 0.88 (0.84-0.94; P<.001 and>
- 11% with SGLT2is: 0.89 (0.83-0.96; P=.001).
- SGLT2i: 0.86 (0.80-0.93); and
- GLP-1RA: 0.87 (0.82-0.92).
- Not reduced with GLP-1RAs: 0.93 (0.83-1.04; P=.20);
- Reduced with SGLT2is: 0.69 (0.61-0.79; P<.001>
- GLP-1RA reduced: 0.82 (0.75-0.89; P<.001>
- Greater reduction with SGLT2is: 0.62 (0.58-0.67; P<.001>
- Patient-level data not included.
- Inclusion/exclusion criteria differed across trials.
- No head-to-head comparisons or examination of combining classes.
- Recent GLP-1RA trial not included.