澳大利亚2型糖尿病患者中，钠-葡萄糖协同转运蛋白2抑制剂与胰高血糖素样肽1受体激动剂相比，心血管事件风险和死亡率的性别差异：一项基于人群的队列研究。

Sex differences in risk of cardiovascular events and mortality with sodium glucose co-transporter-2 inhibitors versus glucagon-like peptide 1 receptor agonists in Australians with type 2 diabetes: a population-based cohort study.

作者信息

Sharma Abhipree, Wood Stephen, Bell J Simon, De Blasio Miles J, Ilomäki Jenni, Ritchie Rebecca H

机构信息

Heart Failure Pharmacology, Drug Discovery Biology, Monash Institute of Pharmaceutical Sciences, Monash University, VIC, Australia.

Centre for Medicine Use and Safety, Monash Institute of Pharmaceutical Sciences, Monash University, VIC, Australia.

出版信息

Lancet Reg Health West Pac. 2023 Jan 31;33:100692. doi: 10.1016/j.lanwpc.2023.100692. eCollection 2023 Apr.

DOI:10.1016/j.lanwpc.2023.100692

PMID:37181530

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10166999/

Abstract

BACKGROUND

Sodium glucose co-transporter-2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1RAs) reduce major adverse cardiovascular events (MACE) in people with type 2 diabetes (T2D). Despite known sex differences in diabetes-induced cardiovascular disease (CVD), pharmacological treatment recommendations are independent of sex. Our objective was to investigate possible sex differences in rates of MACE with SGLT2i vs. GLP-1RA use.

METHODS

This population-based cohort study included men and women with T2D (≥30 years), discharged from a Victorian hospital between 1st July 2013 and 1st July 2017, and dispensed an SGLT2i or GLP-1RA within 60 days of discharge. Using Cox proportional hazards regression with competing risks, subdistribution hazard ratios (sHR) with 95% confidence intervals (CI) were estimated for MACE in a follow-up to 30th June 2018. Analyses were conducted for men and women, and subgroups based on age, baseline heart failure (HF), and atherosclerotic CVD (ASCVD) status.

FINDINGS

From a total of 8026 people (44.3% women, median follow-up time = 756 days), SGLT2i (n = 4231), compared to GLP-1RAs (n = 3795), reduced MACE rates in men (sHR 0.78; 95%CI 0.66-0.93), but not women. SGLT2i reduced MACE rates in men (sHR 0.72; 95%CI 0.54-0.98) and women (sHR 0.52; 95%CI 0.31-0.86) ≥65 years; in men with baseline HF (sHR 0.45; 95%CI 0.28-0.73); and in women with ASCVD (sHR 0.36; 95%CI 0.18-0.71).

INTERPRETATIONS

SGLT2i, relative to GLP-1RAs, demonstrate favourable effects for MACE reductions among older Australian men and women with T2D. Analogous benefits were also observed in men with HF and women with ASCVD.

FUNDING

Dementia Australia Yulgilbar Innovation Award.

摘要

背景

钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）和胰高血糖素样肽1受体激动剂（GLP-1RAs）可降低2型糖尿病（T2D）患者的主要不良心血管事件（MACE）。尽管已知糖尿病诱发的心血管疾病（CVD）存在性别差异，但药物治疗建议并不考虑性别因素。我们的目的是研究使用SGLT2i与GLP-1RA时MACE发生率可能存在的性别差异。

方法

这项基于人群的队列研究纳入了2013年7月1日至2017年7月1日期间从一家维多利亚州医院出院、年龄≥30岁的T2D男性和女性患者，且在出院后60天内使用了SGLT2i或GLP-1RA。采用Cox比例风险回归模型并考虑竞争风险，估计至2018年6月30日随访期间MACE的亚分布风险比（sHR）及95%置信区间（CI）。对男性和女性以及基于年龄、基线心力衰竭（HF）和动脉粥样硬化性心血管疾病（ASCVD）状态的亚组进行了分析。

研究结果

在总共8026名患者（44.3%为女性，中位随访时间 = 756天）中，与GLP-1RA组（n = 3795）相比，SGLT2i组（n = 4231）降低了男性的MACE发生率（sHR 0.78；95%CI 0.66 - 0.93），但对女性没有影响。SGLT2i降低了≥65岁男性（sHR 0.72；95%CI 0.54 - 0.98）和女性（sHR 0.52；95%CI 0.31 - 0.86）的MACE发生率；降低了基线有HF的男性（sHR 0.45；95%CI 0.28 - 0.73）和有ASCVD的女性（sHR 0.36；95%CI 0.18 - 0.71）的MACE发生率。