Cited by 103Diabetes Treatment and ManagementHeart Failure Treatment and ManagementDiabetes, Cardiovascular Risks, and Lipoproteins

Sodium-glucose cotransporter-2 inhibitors versus glucagon-like peptide-1 receptor agonists and the risk for cardiovascular outcomes in routine care patients with diabetes across categories of cardiovascular disease

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Patorno, Elisabetta, Htoo, Phyo T., Glynn, Robert J., Schneeweiss, Sebastian, Wexler, Deborah J., Pawar, Ajinkya, Bessette, Lily G., Chin, Kristyn +2 more·2021·Annals of Internal Medicine

Abstract

BACKGROUND: Both sodium-glucose cotransporter-2 (SGLT2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have shown cardiovascular benefits in placebo-controlled trials of patients with type 2 diabetes (T2D) and established cardiovascular disease (CVD). OBJECTIVE: To evaluate whether SGLT2 inhibitors and GLP-1 RAs are associated with differential cardiovascular benefit among T2D patients with and without CVD. DESIGN: Population-based cohort study. SETTING: Medicare and 2 U.S. commercial claims data sets (April 2013 to December 2017). PARTICIPANTS: 1:1 propensity score-matched adult T2D patients with and without CVD (52 901 and 133 139 matched pairs) initiating SGLT2 inhibitor versus GLP-1 RA therapy. MEASUREMENTS: Primary outcomes were myocardial infarction (MI) or stroke hospitalization and hospitalization for heart failure (HHF). Pooled hazard ratios (HRs) and rate differences (RDs) per 1000 person-years were estimated, with 95% CIs, controlling for 138 preexposure covariates. RESULTS: The initiation of SGLT2 inhibitor versus GLP-1 RA therapy was associated with a slightly lower risk for MI or stroke in patients with CVD (HR, 0.90 [95% CI, 0.82 to 0.98]; RD, -2.47 [CI, -4.45 to -0.50]) but similar risk in those without CVD (HR, 1.07 [CI, 0.97 to 1.18]; RD, 0.38 [CI, -0.30 to 1.07]). The initiation of SGLT2 inhibitor versus GLP-1 RA therapy was associated with reductions in HHF risk regardless of baseline CVD in patients with CVD (HR, 0.71 [CI, 0.64 to 0.79]; RD, -4.97 [CI, -6.55 to -3.39]) and in those without CVD (HR, 0.69 [CI, 0.56 to 0.85]; RD, -0.58 [CI, -0.91 to -0.25]). LIMITATION: Treatment selection was not randomized. CONCLUSION: Use of SGLT2 inhibitors versus GLP-1 RAs was associated with consistent reductions in HHF risk among T2D patients with and without CVD, although the absolute benefit was greater in patients with CVD. There were no large differences in risk for MI or stroke among T2D patients with and without CVD. PRIMARY FUNDING SOURCE: Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School.

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  1. [30]Rothman K GS, Lash T. Modern Epidemiology, 3rd Edition. Philadelphia, PA: Lippincott Williams & Wilkins; 2008.

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Authors
Patorno, E., Htoo, P. T., Glynn, R. J., Schneeweiss, S., Wexler, D. J., Pawar, A., Bessette, L. G., Chin, K., Everett, B. M., & Kim, S. C.
Affiliations
  • Brigham and Women's Hospital (US)
  • Harvard University (US)
Venue
Annals of Internal Medicine
Published
2021-11
Volume
174
Issue
11
Pages
1528-1541
ISSN
  • 0003-4819 (ISSN-L)
  • 1539-3704
OpenAlex
W3201795055
Cited by
103
References
44
Citations by year
2026: 9 · 2025: 17 · 2024: 24 · 2023: 27 · 2022: 23 · 2021: 3
FWCI
14.37
Type
journal article
Language
en
Open access
Locations
  • Annals of Internal Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute on Aging (K08AG055670)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Keywords
SGLT2 inhibitors, GLP-1 receptor agonists, type 2 diabetes, cardiovascular disease, cardiovascular outcomes, myocardial infarction, stroke, heart failure hospitalization, real-world evidence, antidiabetic drug comparison, Medicare beneficiaries, cardiovascular risk reduction, propensity score matching, claims data, glycemic control
MeSH terms
Glucagon-Like Peptide-1 Receptor, Sodium-Glucose Transporter 2 Inhibitors, Glucagon-Like Peptide-1 Receptor Agonists, Aged, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Female, Heart Failure, Hospitalization, Humans, Male, Middle Aged, Myocardial Infarction, United States, Cohort Studies, Matched-Pair Analysis, Stroke

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