Department of Pharmacy, Baylor Scott & White Health, Temple, Texas, and College of Pharmacy, University of Texas at Austin.
Center for Applied Health Research, Baylor Scott & White Health, Temple, Texas.
J Manag Care Spec Pharm. 2020 May;26(5):610-618. doi: 10.18553/jmcp.2020.26.5.610.
Cardiovascular disease (CVD) remains the most prevalent cause of morbidity and mortality in patients with type 2 diabetes (T2D) and is a primary driver for health care costs associated with diabetes management. Sodium-glucose cotransporter-2 inhibitors (SGLT-2is) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have demonstrated significant reductions in cardiovascular endpoints in clinical trials compared with placebo. However, it is uncertain whether these findings can be applied to the broader T2D population because these trials specifically included high-risk patients with established CVD.
To evaluate and compare cardiovascular outcomes among adults with T2D newly initiated on SGLT-2is, GLP-1 RAs, and other antidiabetic medications (oADMs) in a real-world setting.
This retrospective new-user cohort study used administrative claims and electronic health record data from an integrated delivery network in Texas. Patients aged ≥18 years with T2D and ≥1 prescription claim for an SGLT-2i, a GLP-1 RA, or an oADM filled between April 2013 and December 2018 were included. Patients were divided into three 1:1 propensity-matched groups according to index medication identified. Primary outcomes were heart failure hospitalization and a composite end-point of myocardial infarction, stroke, unstable angina, or coronary revascularization. Cox proportional hazards regression was used to compare cumulative incidence of all outcome variables.
Among 9,477 patients, 1,134 were initiated on SGLT-2is, 1,072 on GLP-1 RAs, and 7,271 on oADMs. Patients initiating SGLT-2is versus oADMs had significantly lower risk of the composite endpoint (HR = 0.64, 95% CI = 0.46-0.90), heart failure hospitalization (HR = 0.56, 95% CI = 0.39-0.81), and unstable angina requiring hospitalization (HR = 0.56, 95% CI = 0.39-0.81). Patients initiating GLP-1 RAs compared with oADMs had significantly lower risk of the composite endpoint (HR = 0.71, 95% CI = 0.52-0.98) and unstable angina requiring hospitalization (HR = 0.60, 95% CI = 0.41-0.86). No differences in cardiovascular outcomes were found between SGLT-2is and GLP-1 RAs.
Both SGLT-2is and GLP-1 RAs showed significant reductions in the composite outcome and unstable angina requiring hospitalization versus oADMs. However, only SGLT-2is were associated with a lower risk for heart failure hospitalizations. Nevertheless, cardiovascular outcomes were similar between SGLT-2is and GLP-1 RAs.
No outside funding supported this study. The authors have no conflicts of interest to report.
心血管疾病（CVD）仍是 2 型糖尿病（T2D）患者发病率和死亡率最高的原因，也是与糖尿病管理相关的医疗保健费用的主要驱动因素。钠-葡萄糖共转运蛋白-2 抑制剂（SGLT-2is）和胰高血糖素样肽-1 受体激动剂（GLP-1 RAs）在临床试验中与安慰剂相比，显著降低了心血管终点事件。然而，尚不确定这些发现是否可以应用于更广泛的 T2D 人群，因为这些试验特别纳入了有明确 CVD 的高危患者。
评估和比较在真实环境中，新开始使用 SGLT-2is、GLP-1 RAs 和其他抗糖尿病药物（oADMs）的 T2D 成年人的心血管结局。
这是一项回顾性新用户队列研究，使用了德克萨斯州一个综合交付网络的行政索赔和电子健康记录数据。年龄≥18 岁、有 T2D 且在 2013 年 4 月至 2018 年 12 月期间至少有一次 SGLT-2i、GLP-1 RA 或 oADM 处方的患者被纳入研究。患者根据索引药物分为三组，每组 1:1 进行倾向评分匹配。主要结局是心力衰竭住院和心肌梗死、卒中和不稳定型心绞痛或冠状动脉血运重建的复合终点。使用 Cox 比例风险回归比较所有结局变量的累积发生率。
在 9477 名患者中，有 1134 名患者开始使用 SGLT-2is，1072 名患者开始使用 GLP-1 RAs，7271 名患者开始使用 oADMs。与 oADMs 相比，开始使用 SGLT-2is 的患者复合终点（HR = 0.64，95%CI = 0.46-0.90）、心力衰竭住院（HR = 0.56，95%CI = 0.39-0.81）和需要住院治疗的不稳定型心绞痛（HR = 0.56，95%CI = 0.39-0.81）的风险显著降低。与 oADMs 相比，开始使用 GLP-1 RAs 的患者复合终点（HR = 0.71，95%CI = 0.52-0.98）和需要住院治疗的不稳定型心绞痛（HR = 0.60，95%CI = 0.41-0.86）的风险显著降低。在心血管结局方面，SGLT-2is 和 GLP-1 RAs 之间没有差异。
SGLT-2is 和 GLP-1 RAs 与 oADMs 相比，复合结局和需要住院治疗的不稳定型心绞痛均显著降低。然而，只有 SGLT-2is 与心力衰竭住院风险降低相关。尽管如此，SGLT-2is 和 GLP-1 RAs 的心血管结局相似。
本研究无外部资金支持。作者没有利益冲突要报告。
