Comparative cardiovascular safety of GLP-1 receptor agonists versus other glucose-lowering agents in real-world patients with type 2 diabetes: a nationwide population-based cohort study - PubMed (original) (raw)

Observational Study

Comparative cardiovascular safety of GLP-1 receptor agonists versus other glucose-lowering agents in real-world patients with type 2 diabetes: a nationwide population-based cohort study

Chun-Ting Yang et al. Cardiovasc Diabetol. 2020.

Abstract

Background: Current evidence about the cardiovascular safety of glucagon-like peptide-1 receptor agonist (GLP-1ra) possesses limited generalizability to real-world patients with type 2 diabetes (T2D) in usual practice. This study aimed to investigate the comparative cardiovascular safety of GLP-1ra in comparisons with dipeptidyl peptidase-4 inhibitor (DPP-4i), sulfonylurea (SU), and insulin in a real-world population with T2D.

Methods: Adults with newly-diagnosed T2D were identified from Taiwan's National Health Insurance Research Database in 2003-2014. A prevalent new-user cohort design was adopted to include a broad representation of real-world T2D patients being treated with GLP-1ra. The between-group comparability of baseline patient characteristics was achieved by matching on (1) initiation time of study drugs, (2) prior exposure to glucose-lowering agents, and (3) diabetes severity and complications, comorbidities, and concomitant cardiovascular medications using propensity scores. The primary outcome was a composite of cardiovascular disease (CVD) events and assessed up to the end of 2015. Cox modeling was employed to assess the association between study drugs and outcomes.

Results: A total of 3195 GLP-1ra stable users was identified in 2011-2014. 1893, 1829, and 1367 GLP-1ra stable users were 1:1 matched to DPP-4i, SU and insulin users, respectively. Compared to DPP-4i, SU and insulin, the use of GLP-1ra was associated with a lower risk of composite CVD events [hazard ratio (95% confidence interval) 0.73 (0.57-0.96), 0.76 (0.57-1.00), and 0.81 (0.62-1.07), respectively]. Subgroup analyses revealed that GLP-1ra versus DPP-4i yielded a greater cardiovascular benefit in those without established CVD versus those with established CVD.

Conclusions: This comparison study extends the supporting evidence for the cardiovascular safety of GLP-1ra to a broad spectrum of real-world T2D patients using GLP-1ra.

Keywords: Cardiovascular safety; DPP-4 inhibitor; GLP-1 receptor agonist; Insulin; Sulfonylurea.

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Conflict of interest statement

No competing interests to be declared.

Figures

Fig. 1

Fig. 1

Flowchart of study population selection and identification

Fig. 2

Fig. 2

Primary and subgroup analyses for composite CVD associated with GLP-1ra versus other glucose-lowering agentsa. CVD, cardiovascular disease; DM, diabetes mellitus; DPP-4i, dipeptidyl peptidase-4 inhibitor; GLP-1ra, glucagon-like peptide-1 receptor agonist; HR, hazard ratio; MVD, microvascular disease; SU, sulfonylurea. aComposite CVD was a composite outcome that included acute myocardial infarction, ischemic heart disease, heart failure, stroke, cardiogenic shock, sudden cardiac arrest, arteriosclerotic cardiovascular disease, and arrhythmia. *In the testing of interaction in subgroup analyses, a p value of less than 0.05 was considered statistically significant

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