Endocrinology, Cleveland Clinic, Cleveland, Ohio.
Novo Nordisk, Plainsboro, New Jersey.
Diabetes Obes Metab. 2017 Nov;19(11):1555-1561. doi: 10.1111/dom.12969. Epub 2017 Jul 5.
To assess the potential impact of glucagon-like peptide-1 receptor agonist (GLP-1RA) exposure on cardiovascular disease (CVD) and mortality outcomes in patients with type 2 diabetes (T2D), using a large retrospective cohort.
Patients who had T2D between 2005 and 2014 (N = 105 862) were identified from the electronic health record system at Cleveland Clinic using a validated electronic phenotype. A time-dependent, Cox, multiple regression analysis was used to assess the association between GLP-1RA exposure and risk of acute myocardial infarction (AMI), stroke/cerebrovascular accident (CVA), and overall mortality, as well as the composite of all three outcomes. The findings were further evaluated by assessing the effect of GLP-1RAs on the same variables in patients with and without prior CVD. The model adjusted for differences in demographic information, hypertension, laboratory/vital signs, history of outcomes, and T2D medications.
There were significantly lower rates of AMI (hazard ratio [HR] 0.80, 95% confidence interval [CI] 0.65 to 0.99; P = .045), CVA (HR 0.82, 95% CI 0.74 to 0.91, P < .001), overall mortality (HR 0.48, 95% CI 0.41 to 0.57; P < .001), and the composite outcome (HR 0.82, 95% CI 0.74 to 0.91; P < .002) during the consolidated time that patients were exposed to GLP-1RAs compared to corresponding rates during intervals without GLP-1RA exposure. GLP-1RA treatment was associated with a significant decrease in CVA, mortality, and the composite outcome in patients with and without established CVD, not significantly affecting AMI in these subgroups.
GLP-1RA exposure was found to be associated with a reduction in the risk of cardiovascular events observed and overall mortality among patients with T2D with and without established CVD, after adjusting for potential confounders.
利用大型回顾性队列研究，评估胰高血糖素样肽-1 受体激动剂（GLP-1RA）暴露对 2 型糖尿病（T2D）患者心血管疾病（CVD）和死亡率结局的潜在影响。
使用克利夫兰诊所电子病历系统中的经过验证的电子表型，从 2005 年至 2014 年期间确定了患有 T2D 的患者（N=105862）。采用时间依赖性 Cox 多重回归分析评估 GLP-1RA 暴露与急性心肌梗死（AMI）、中风/脑血管意外（CVA）和全因死亡率风险之间的关联，以及所有三个结局的综合风险。还通过评估 GLP-1RA 在有和无既往 CVD 的患者中对相同变量的影响来进一步评估研究结果。该模型调整了人口统计学信息、高血压、实验室/生命体征、结局史和 T2D 药物治疗的差异。
与无 GLP-1RA 暴露期间相比，GLP-1RA 暴露患者的 AMI（风险比 [HR] 0.80，95%置信区间 [CI] 0.65 至 0.99；P=0.045）、CVA（HR 0.82，95% CI 0.74 至 0.91，P<0.001）、全因死亡率（HR 0.48，95% CI 0.41 至 0.57；P<0.001）和复合结局（HR 0.82，95% CI 0.74 至 0.91；P<0.002）的发生率显著降低。在同时暴露于 GLP-1RA 的时间内，GLP-1RA 治疗与 CVA、死亡率和复合结局风险的显著降低相关，在这些亚组中，对 AMI 没有显著影响。
在调整了潜在混杂因素后，发现 GLP-1RA 暴露与 T2D 患者（无论是否存在已确立的 CVD）心血管事件和全因死亡率风险降低相关。
