Comparative effectiveness of SGLT2i versus GLP1-RA on cardiovascular outcomes in routine clinical practice. (1st April 2022)

• Record Type: Journal Article
• Authors: Fu, Edouard L.; Clase, Catherine M.; Janse, Roemer J.; Lindholm, Bengt; Dekker, Friedo W.; Jardine, Meg J.; Carrero, Juan-Jesus
• Is Part Of: International journal of cardiology. Volume 352(2022)
• Page Start: 172
• Page End: 179
• Publication Date: 2022-04-01
• Subjects: Sodium-glucose transporter 2 inhibitors -- Glucagon-like peptide-1 receptor agonist -- Diabetes mellitus type 2 -- Comparative effectiveness -- Cardiovascular drug -- Cohort observational study; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2022.01.042
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: To investigate the comparative effectiveness of sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP1-RA) on cardiovascular outcomes in routine clinical practice, which have never been directly compared in head-to-head outcome trials. Methods: We compared outcomes of adults who newly started SGLT2i or GLP1-RA therapy in Stockholm, Sweden, during 2013–2019. The primary outcome was major adverse cardiovascular events (MACE), a composite of cardiovascular (CV) death, myocardial infarction and stroke. Secondary outcomes included the individual MACE components and hospitalization for heart failure. Cox regression with propensity score overlap weighting was used to estimate hazard ratios (HRs) with 95% confidence intervals and adjust for 57 covariates. Results: We included 12, 375 individuals, of which 5489 initiated SGLT2i and 6886 GLP1-RA therapy, followed for median 1.6 years. Mean age was 61 years and 37.6% were women. Compared with GLP1-RA, SGLT2i new users had similar risk of MACE risk (adjusted HR 1.04; 95% CI 0.83–1.31). The adjusted HRs (95% CI) for SGLT2i vs. GLP1-RA were 0.80 (0.59–1.09) for heart failure hospitalization, 0.95 (0.58–1.55) for cardiovascular death, 0.91 (0.67–1.24) for myocardial infarction and 1.71 (1.14–2.59) for ischemic stroke (5-year absolute risk difference for stroke 1.9% [95% CI 0.8–3.0]). Conclusions: In a largely primary-prevention population of people undergoing routine care, no differences were observed in MACE risk among initiators of SGLT2i and GLP1-RA. However, compared with GLP1RA, the use of SGLT2i was associated with an increased risk of ischemic stroke that was small in absolute magnitude. Highlights: In this study of 12, 375 individuals from routine clinical care, new users of SGLT2i had similar risk of major adverse cardiovascular events compared with new users of GLP1-RA. However, initiation of SGLT2i vs. GLP1-RA was associated with an increased risk of ischemic stroke, although absolute risk differences were small.