每周一次胰高血糖素样肽-1 受体激动剂与二肽基肽酶-4 抑制剂：伴有心血管疾病的糖尿病患者的心血管效应。
Once-weekly glucagon-like peptide-1 receptor agonists vs dipeptidyl peptidase-4 inhibitors: cardiovascular effects in people with diabetes and cardiovascular disease.
机构信息
Novo Nordisk Inc., Plainsboro, NJ, USA.
Department of Endocrinology, Yale University, New Haven, CT, USA.
出版信息
Cardiovasc Diabetol. 2023 Nov 20;22(1):319. doi: 10.1186/s12933-023-02051-8.
BACKGROUND
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), which have proven cardiovascular benefits, are recommended in people with type 2 diabetes (T2D) and atherosclerotic cardiovascular disease (ASCVD). However, there is limited real-world evidence comparing the effects of once-weekly (OW) GLP-1 RAs and dipeptidyl peptidase-4 inhibitors (DPP-4is). This observational cohort study (1/1/2017-9/30/2021) used data from the Optum Clinformatics Data Mart to compare time to incident clinical cardiovascular outcomes, health care resource utilization (HCRU), and medical costs in new adult users of OW GLP-1 RAs and DPP-4is with T2D and ASCVD.
METHODS
Time to occurrence of ischemic stroke, myocardial infarction (MI), or their composite and ASCVD-related and all-cause HCRU and medical costs were investigated. Baseline characteristics were balanced using inverse probability of treatment weighting. Survival analyses were conducted to compare risks during exposure.
RESULTS
OW GLP-1 RA users (weighted N = 25,287) had 26%, 22%, and 24% lower risk of ischemic stroke, MI, and their composite, respectively, compared with DPP-4i users (weighted N = 39,684; all P < 0.01). Compared with DPP-4i users, OW GLP-1 RA users had 25% and 26% lower ASCVD-related and all-cause hospitalization costs, 19% and 23% lower ASCVD-related and all-cause medical costs, 23% and 27% fewer ASCVD-related and all-cause hospitalizations, 13% and 8% fewer ASCVD-related and all-cause outpatient visits, and 8% fewer all-cause ER visits (all P < 0.01).
CONCLUSIONS
In adults with T2D and ASCVD, OW GLP-1 RAs are associated with reduced stroke and MI risks and ASCVD-related and all-cause HCRU and costs vs DPP-4is.
背景
胰高血糖素样肽-1 受体激动剂（GLP-1 RAs）已被证明具有心血管益处，推荐用于 2 型糖尿病（T2D）和动脉粥样硬化性心血管疾病（ASCVD）患者。然而，关于每周一次（OW）GLP-1 RA 和二肽基肽酶-4 抑制剂（DPP-4i）的实际效果比较，目前仅有有限的证据。这项观察性队列研究（1/1/2017-9/30/2021）使用 Optum Clinformatics Data Mart 中的数据，比较了新确诊的 T2D 和 ASCVD 成人患者中 OW GLP-1 RA 和 DPP-4i 的临床心血管结局、医疗资源利用（HCRU）和医疗成本的发生时间。
方法
研究了缺血性卒中、心肌梗死（MI）或其复合事件以及 ASCVD 相关和全因 HCRU 和医疗成本的发生时间。通过逆概率治疗加权来平衡基线特征。进行生存分析以比较暴露期间的风险。
结果
与 DPP-4i 使用者（加权 N=39684）相比，OW GLP-1 RA 使用者（加权 N=25287）发生缺血性卒中、MI 和复合事件的风险分别降低 26%、22%和 24%（均 P<0.01）。与 DPP-4i 使用者相比，OW GLP-1 RA 使用者的 ASCVD 相关和全因住院费用分别降低 25%和 26%，ASCVD 相关和全因医疗费用分别降低 19%和 23%，ASCVD 相关和全因住院次数分别减少 23%和 27%，ASCVD 相关和全因门诊就诊次数分别减少 13%和 8%，全因急诊就诊次数减少 8%（均 P<0.01）。
结论
在患有 T2D 和 ASCVD 的成年人中，OW GLP-1 RA 与降低卒中、MI 风险以及 ASCVD 相关和全因 HCRU 和成本相关，与 DPP-4i 相比。
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