胰高血糖素样肽-1受体激动剂和钠-葡萄糖协同转运蛋白2抑制剂潜在未实现的死亡率获益：退伍军人健康管理局临床评估、报告与追踪项目的一份报告
Potential unrealized mortality benefit of glucagon-like peptide-1 receptor agonists and sodium-glucose co-transport-2 inhibitors: A report from the Veterans Health Administration Clinical Assessment, Reporting and Tracking program.
作者信息
Salahuddin Taufiq, Richardson Vanessa, McNeal Demetria M, Henderson Kamal, Hess Paul L, Raghavan Sridharan, Saxon David R, Valle Javier A, Waldo Stephen W, Ho P Michael, Schwartz Gregory G
机构信息
Cardiology Section, Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA.
University of Colorado School of Medicine, Aurora, Colorado, USA.
出版信息
Diabetes Obes Metab. 2021 Jan;23(1):97-105. doi: 10.1111/dom.14193. Epub 2020 Oct 3.
AIM
To assess the unrealized potential of glucagon-like peptide-1 receptor agonist (GLP-1RA) or sodium-glucose co-transport-2 inhibitor (SGLT2i) use to reduce mortality in veterans with type 2 diabetes (T2D), coronary artery disease (CAD), and other characteristics congruent with clinical trial cohorts that established the efficacy of these agents.
METHODS
Veterans with T2D and CAD on angiography in 2014 who were untreated with either a GLP-1RA or a SGLT2i were assessed for key eligibility criteria of the LEADER (GLP-1RA) and EMPA-REG OUTCOME (SGLT2i) trials. Trial hazard ratios and 95% confidence intervals for all-cause death were applied to deaths observed in veterans through 2018 to estimate the potential benefit of GLP-1RA or SGLT2i use.
RESULTS
Median observation was 4.3 years. Of 15 987 veterans with T2D and CAD, 1186 (7.4%) were excluded for GLP-1RA or SGLT2i treatment, and 1386 lacked glycated haemoglobin measurement. Of the remaining 13 415 patients, 4103 (30.1%) and 5313 (39.6%) fulfilled the key criteria for the LEADER and EMPA-REG OUTCOME trials, respectively. Death occurred in 1009 (24.6%) of LEADER-eligible patients and 1335 (25.1%) of EMPA-REG OUTCOME-eligible patients. Under treatment with liraglutide in LEADER-eligible veterans, a 3.5% (0.7%-6.2%) potential absolute mortality reduction, corresponding to 144 (28-253) fewer deaths (0.88 [0.17-1.56] per 100 person-years), might have been expected. Similarly, under treatment with empagliflozin in EMPA-REG OUTCOME-eligible veterans, a 7.9% (4.5%-10.8%) potential absolute mortality reduction, corresponding to 418 (230-573) fewer deaths (1.98 [1.14-2.72] per 100 person-years), might have been expected.
CONCLUSIONS
This analysis indicates unrealized opportunities to reduce mortality in selected veterans with T2D and CAD via increased GLP-1RA and SGLT2i use.
目的
评估胰高血糖素样肽-1受体激动剂（GLP-1RA）或钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）在降低2型糖尿病（T2D）、冠状动脉疾病（CAD）退伍军人死亡率方面尚未实现的潜力，这些退伍军人具有与确立这些药物疗效的临床试验队列相符的其他特征。
方法
对2014年接受血管造影检查、未接受GLP-1RA或SGLT2i治疗的T2D和CAD退伍军人进行评估，以确定LEADER（GLP-1RA）和EMPA-REG OUTCOME（SGLT2i）试验的关键纳入标准。将试验中全因死亡的风险比和95%置信区间应用于截至2018年观察到的退伍军人死亡情况，以估计使用GLP-RA或SGLT2i的潜在益处。
结果
中位观察时间为4.3年。在15987名患有T2D和CAD的退伍军人中，1186人（7.4%）因接受GLP-1RA或SGLT2i治疗而被排除，1386人缺乏糖化血红蛋白测量值。在其余13415名患者中，分别有4103人（30.1%）和5313人（39.6%）符合LEADER和EMPA-REG OUTCOME试验的关键标准。符合LEADER试验标准的患者中有1009人（24.6%）死亡，符合EMPA-REG OUTCOME试验标准的患者中有1335人（25.1%）死亡。在符合LEADER试验标准且接受利拉鲁肽治疗的退伍军人中，可能预期绝对死亡率降低3.5%（0.7%-6.2%），相当于死亡人数减少144人（28-253人）（每100人年0.88[0.17-1.56]）。同样，在符合EMPA-REG OUTCOME试验标准且接受恩格列净治疗的退伍军人中，可能预期绝对死亡率降低7.9%（4.5%-10.8%），相当于死亡人数减少418人（230-573人）（每100人年1.98[1.14-2.72]）。
结论
该分析表明，通过增加GLP-1RA和SGLT2i的使用，在特定的T2D和CAD退伍军人中存在尚未实现的降低死亡率的机会。
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