GLP1RA added to antidiabetic drugs prevents MACE, HF hospitalization

Adding glucagon-like peptide-1 receptor agonists (GLP1RA) onto metformin, sulfonylurea, or insulin treatment alone or in combination appears to reduce the incidence of major adverse cardiac events (MACE) and heart failure (HF) hospitalization relative to treatment with dipeptidyl peptidase-4 inhibitors (DPP4i), suggests a study.

In contrast, the addition of sodium–glucose cotransporter-2 inhibitors (SGLT2i) does not seem to result in primary MACE prevention.

US veterans aged ≥18 years receiving care from the Veterans Health Administration, with data linkage to Medicare, Medicaid, and the National Death Index were included in this retrospective study from 2001 to 2019. Participants added GLP1RA, SGLT2i, or DPP4i onto metformin, sulfonylurea, or insulin treatment alone or in combination.

The investigators stratified episodes by history of . MACE (ie, acute myocardial infarction, stroke, or cardiovascular death) and HF hospitalization were the study outcomes. Cox models were generated to compare outcomes between medication groups using pairwise comparisons in a weighted cohort, with adjustments for covariates.

Overall, 28,759 GLP1RA vs 28,628 DPP4i weighted pairs and 21,200 SGLT2i vs 21,170 DPP4i weighted pairs were included. The median age of veterans was 67 years, and their diabetes duration was 8.5 years.

Treatment with GLP1RAs resulted in reduced MACE and HF incidence when compared with DPP4i (adjusted hazard ratio [aHR], 0.82, 95 percent confidence interval [CI], 0.72‒0.94; adjusted risk difference [aRD], 3.2 events per 1,000 person-years, 95 percent CI, 1.1‒5.0).

On the other hand, SGLT2is were not preventive of MACE and HF (aHR, 0.91, 95 percent CI, 0.78‒1.08; aRD, 1.28, 95 percent CI, ‒1.12 to 3.32) compared with DPP4i.