Thompson Wade, Wong Brendan, Sivaswamy Atul, Ferreira-Legere Laura, Lee Douglas S, Abdel-Qadir Husam, Ko Dennis T, Weisman Alanna, Tobe Sheldon, Jackevicius Cynthia A, Goodman Shaun G, Farkouh Michael E, Udell Jacob A
Women's College Research Institute, Toronto, Ontario, Canada.
ICES, Toronto, Ontario, Canada.
CJC Open. 2025 Feb 18;7(8):1055-1061. doi: 10.1016/j.cjco.2025.02.008. eCollection 2025 Aug.
A cardiovascular (CV) hospitalization is a seminal opportunity to implement guideline-directed medical therapy (GDMT). Sodium-glucose transporter 2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP1RAs) can improve outcomes among those with type 2 diabetes mellitus (T2DM) and CV disease.
We conducted a population-based cohort study among patients aged ≥ 66 years with T2DM in Ontario hospitalized for a CV event (myocardial infarction, heart failure, peripheral arterial disease, ischemic stroke) from June 2015 to March 2022, who were followed until March 2023. We examined use of GDMT before vs after the index event, including use of SGLT2is, GLP1RAs, statins, and others medications.
We identified 75,869 people aged ≥ 66 years with T2DM (median age 78 years; 43% female). The proportion receiving SGLT2is was 9% before index hospitalization and 29% during the follow-up period. GLP1RA was used for 1% before vs 9% after, compared with 65% before and 86% after for statins. Use of novel GDMT increased across the follow-up period. The incidence of SGLT2i use 1-year posthospitalization was 4% in 2016 vs 39% in 2021; for GLP1RA use, the incidence was 0% in 2016 vs 11% in 2021.
A rise in the use of novel GDMT suggests increasing adoption of therapies to optimize secondary prevention in patients with T2DM and CV disease after index CV events.
心血管疾病（CV）住院是实施指南指导的药物治疗（GDMT）的重要契机。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（GLP1RA）可改善2型糖尿病（T2DM）合并心血管疾病患者的预后。
我们在安大略省对2015年6月至2022年3月因心血管事件（心肌梗死、心力衰竭、外周动脉疾病、缺血性中风）住院的≥66岁T2DM患者进行了一项基于人群的队列研究，随访至2023年3月。我们比较了索引事件前后GDMT的使用情况，包括SGLT2i、GLP1RA、他汀类药物和其他药物的使用。
我们确定了75869名≥66岁的T2DM患者（中位年龄78岁；43%为女性）。索引住院前接受SGLT2i治疗的比例为9%，随访期间为29%。GLP1RA治疗的比例在索引住院前为1%，之后为9%，而他汀类药物治疗的比例在索引住院前为65%，之后为86%。在随访期间，新型GDMT的使用有所增加。201６年住院后1年使用SGLT2i的发生率为4%，2021年为39%；对于GLP1RA治疗，2016年的发生率为0%，2021年为11%。
新型GDMT使用的增加表明，在索引心血管事件后，越来越多的患者采用了优化二级预防的治疗方法。
