Bolden Demetria M, Richardson Vanessa, Salahuddin Taufiq, Henderson Kamal, Hess Paul L, Raghavan Sridharan, Saxon David R, Ho P Michael, Waldo Stephen W, Schwartz Gregory G
Denver-Seattle Center of Innovation for Veteran Centered and Value Driven Care, Aurora, CO, USA.
Department of Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
Am J Prev Cardiol. 2025 Apr 7;22:100966. doi: 10.1016/j.ajpc.2025.100966. eCollection 2025 Jun.
Adoption of novel therapeutics often lags for Black versus non-Hispanic White patients. Seminal clinical trials established the cardiovascular efficacy of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) in patients with type 2 diabetes (T2D) and established atherosclerotic cardiovascular disease. However, it is uncertain whether race influences the evidence-based prescription of these agents.
To determine whether evidence-based prescription of SGLT2i or GLP-1RA differs by Black versus White race in the Veterans Affairs (VA) healthcare system.
Retrospective cohort study of US Veterans with T2D and angiographically confirmed coronary artery disease (CAD) at 84 VA medical centers over the period 2015-2023. Data from the VA Clinical Assessment, Reporting, and Tracking Program were used to construct cohorts eligible for SGLT2i or GLP-1RA treatment based on eligibility criteria for the seminal Empagliflozin, Cardiovascular Outcomes, and Mortality in T2D (EMPA-REG OUTCOME) or the Liraglutide Effect and Action in Diabetes (LEADER) trial, respectively. Multivariable logistic regression estimated adjusted odds of trial-concordant SGLT2i or GLP-1RA prescription by race.
Self-identified race.
SGLT2i or GLP-1RA prescription among those with an evidence-based (trial-concordant) indication.
Of 63,561 Veterans with T2D and CAD, 3527 Black and 18,668 White patients met criteria for trial-concordant SGLT2i treatment and 2020 Black and 10,103 White patients for GLP1-RA treatment. Trial-concordant prescription of both classes increased over time for both races but reached only 42 % for SGLT2i and 15 % for GLP1-RA in 2023. Black versus White race was not associated with evidence-based SGLT2i prescription (adjusted odds ratio [OR] 0.96, 95 % CI 0.89-1.04, = 0.32). However, Black Veterans were less likely than White to be provided with a trial-concordant GLP1-RA prescription (adjusted OR 0.85, 95 % CI 0.74-0.98, = 0.025).
Among patients with T2D and CAD in the VA healthcare system, evidence-based SGLT2i and GLP1-RA prescription increased over time, but many eligible patients remained untreated. Although SGLT2i prescription did not differ by race, Black versus White Veterans were less likely to receive evidence-based GLP1-RA prescription. Racial disparities in evidence-based cardiovascular drug prescription exist even in a healthcare system with few economic barriers and may be drug class-specific.
与非西班牙裔白人患者相比，黑人患者对新型疗法的采用往往滞后。开创性的临床试验确立了钠-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-1RA）在2型糖尿病（T2D）合并动脉粥样硬化性心血管疾病患者中的心血管疗效。然而，种族是否会影响这些药物的循证处方尚不确定。
确定在退伍军人事务部（VA）医疗系统中，SGLT2i或GLP-1RA的循证处方在黑人和白人之间是否存在差异。
设计、设置和参与者：对2015年至2023年期间在84个VA医疗中心患有T2D且经血管造影证实患有冠状动脉疾病（CAD）的美国退伍军人进行回顾性队列研究。VA临床评估、报告和跟踪项目的数据用于根据开创性的恩格列净、心血管结局和2型糖尿病死亡率（EMPA-REG OUTCOME）试验或利拉鲁肽在糖尿病中的作用和疗效（LEADER）试验的资格标准，构建符合SGLT2i或GLP-1RA治疗条件的队列。多变量逻辑回归估计按种族划分的试验一致性SGLT2i或GLP-1RA处方的调整优势比。
自我认定的种族。
有循证（试验一致性）指征者中SGLT2i或GLP-1RA的处方情况。
在63561例患有T2D和CAD的退伍军人中，3527例黑人患者和18668例白人患者符合试验一致性SGLT2i治疗标准，2020例黑人患者和10103例白人患者符合GLP-1RA治疗标准。两个种族的这两类药物的试验一致性处方随时间均有所增加，但在2023年，SGLT2i仅达到42%，GLP-1RA仅达到15%。黑人与白人种族与循证SGLT2i处方无关（调整优势比[OR]为0.96，95%置信区间为0.89 - 1.04，P = 0.32）。然而，黑人退伍军人比白人退伍军人获得试验一致性GLP-1RA处方的可能性更小（调整OR为0.85，95%置信区间为0.74 - 0.98，P = 0.025）。
在VA医疗系统中患有T2D和CAD的患者中，循证SGLT2i和GLP-1RA处方随时间增加，但许多符合条件的患者仍未得到治疗。虽然SGLT2i处方在种族上没有差异，但与白人退伍军人相比，黑人退伍军人接受循证GLP-1RA处方的可能性更小。即使在一个几乎没有经济障碍的医疗系统中，循证心血管药物处方的种族差异仍然存在，并且可能因药物类别而异。
