钠-葡萄糖共转运蛋白 2 抑制剂与胰高血糖素样肽-1 受体激动剂在心血管疾病不同类别患者中常规治疗的糖尿病患者心血管结局风险的比较。
Sodium-Glucose Cotransporter-2 Inhibitors Versus Glucagon-like Peptide-1 Receptor Agonists and the Risk for Cardiovascular Outcomes in Routine Care Patients With Diabetes Across Categories of Cardiovascular Disease.
机构信息
Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (E.P., P.T.H., R.J.G., S.S., A.P., L.G.B., K.C., B.M.E., S.C.K.).
Massachusetts General Hospital Diabetes Center, Harvard Medical School, Boston, Massachusetts (D.J.W.).
出版信息
Ann Intern Med. 2021 Nov;174(11):1528-1541. doi: 10.7326/M21-0893. Epub 2021 Sep 28.
BACKGROUND
Both sodium-glucose cotransporter-2 (SGLT2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have shown cardiovascular benefits in placebo-controlled trials of patients with type 2 diabetes (T2D) and established cardiovascular disease (CVD).
OBJECTIVE
To evaluate whether SGLT2 inhibitors and GLP-1 RAs are associated with differential cardiovascular benefit among T2D patients with and without CVD.
DESIGN
Population-based cohort study.
SETTING
Medicare and 2 U.S. commercial claims data sets (April 2013 to December 2017).
PARTICIPANTS
1:1 propensity score-matched adult T2D patients with and without CVD (52 901 and 133 139 matched pairs) initiating SGLT2 inhibitor versus GLP-1 RA therapy.
MEASUREMENTS
Primary outcomes were myocardial infarction (MI) or stroke hospitalization and hospitalization for heart failure (HHF). Pooled hazard ratios (HRs) and rate differences (RDs) per 1000 person-years were estimated, with 95% CIs, controlling for 138 preexposure covariates.
RESULTS
The initiation of SGLT2 inhibitor versus GLP-1 RA therapy was associated with a slightly lower risk for MI or stroke in patients with CVD (HR, 0.90 [95% CI, 0.82 to 0.98]; RD, -2.47 [CI, -4.45 to -0.50]) but similar risk in those without CVD (HR, 1.07 [CI, 0.97 to 1.18]; RD, 0.38 [CI, -0.30 to 1.07]). The initiation of SGLT2 inhibitor versus GLP-1 RA therapy was associated with reductions in HHF risk regardless of baseline CVD in patients with CVD (HR, 0.71 [CI, 0.64 to 0.79]; RD, -4.97 [CI, -6.55 to -3.39]) and in those without CVD (HR, 0.69 [CI, 0.56 to 0.85]; RD, -0.58 [CI, -0.91 to -0.25]).
LIMITATION
Treatment selection was not randomized.
CONCLUSION
Use of SGLT2 inhibitors versus GLP-1 RAs was associated with consistent reductions in HHF risk among T2D patients with and without CVD, although the absolute benefit was greater in patients with CVD. There were no large differences in risk for MI or stroke among T2D patients with and without CVD.
PRIMARY FUNDING SOURCE
Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School.
背景
钠-葡萄糖协同转运蛋白 2（SGLT2）抑制剂和胰高血糖素样肽-1 受体激动剂（GLP-1 RAs）在有 2 型糖尿病（T2D）和已确诊心血管疾病（CVD）的患者的安慰剂对照试验中均显示出心血管益处。
目的
评估 SGLT2 抑制剂和 GLP-1 RAs 是否与 T2D 患者伴或不伴 CVD 时的心血管获益存在差异。
设计
基于人群的队列研究。
设置
医疗保险和 2 个美国商业索赔数据集（2013 年 4 月至 2017 年 12 月）。
参与者
1:1 倾向评分匹配的伴或不伴 CVD 的成年 T2D 患者（52901 对和 133139 对匹配对）开始接受 SGLT2 抑制剂与 GLP-1 RA 治疗。
测量
主要结局为心肌梗死（MI）或卒中住院和心力衰竭（HFH）住院。估计了每 1000 人年的累积风险比（HR）和率差（RD），采用 95%CI，控制了 138 种暴露前协变量。
结果
与 GLP-1 RA 相比，SGLT2 抑制剂起始治疗与 CVD 患者的 MI 或卒中风险略有降低（HR，0.90 [95%CI，0.82 至 0.98]；RD，-2.47 [CI，-4.45 至 -0.50]），但在无 CVD 患者中风险相似（HR，1.07 [CI，0.97 至 1.18]；RD，0.38 [CI，-0.30 至 1.07]）。与 GLP-1 RA 相比，SGLT2 抑制剂起始治疗与 CVD 患者的 HFH 风险降低相关（HR，0.71 [CI，0.64 至 0.79]；RD，-4.97 [CI，-6.55 至 -3.39]），在无 CVD 患者中也有类似的风险（HR，0.69 [CI，0.56 至 0.85]；RD，-0.58 [CI，-0.91 至 -0.25]）。
局限性
治疗选择不是随机的。
结论
在有或没有 CVD 的 T2D 患者中，与 GLP-1 RA 相比，使用 SGLT2 抑制剂与 HFH 风险降低相关，尽管 CVD 患者的绝对获益更大。在有或没有 CVD 的 T2D 患者中，MI 或卒中的风险没有明显差异。
主要资金来源
布莱根妇女医院和哈佛医学院医学部的药物流行病学和药物经济学部的药物流行病学和药物经济学部。
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