Introduction: Clinical trials have shown cardiovascular disease (CVD) benefits associated with glucagon-like peptide 1 receptor agonists (GLP-1ra) vs. placebo in patients with type 2 diabetes (T2DM). However, only few rigorous clinical trials and real-world studies exist for head-to-head comparison of GLP-1ra with other glucose-lowering agents (GLA). We aimed to investigate CV outcomes of GLP-1ra vs. dipeptidyl peptidase 4 inhibitors (DPP-4i), sulfonylureas (SU), and insulin.
Method: A nationwide cohort study was conducted using Taiwan’s National Health Insurance Research Database. Study cohort consisted of patients older than 18 years old and diagnosed with T2DM during 2004-2014, and followed until death or the end of 2015. Prevalent new-user design was adapted where all users who initiated GLP-1ra stably were retained for analyses and the comparability between GLP-1ra and other GLA users was matched by various confounders in patient characteristics. Study outcomes included composite CVD and 3-point major adverse CV event (MACE). Cox models were employed to assess the association between drug exposure and study outcomes.
Result: After 1:1 propensity score matching, 1,893, 1,573, and 1,367 GLP-1ra users were compared to DPP-4i, SU, and insulin users, respectively. Using GLP-1ra was associated with significantly lower risks of composite CVD (GLP-1ra vs. DPP-4i, SU, and insulin: hazard ratio, 0.73 [95% confidence interval, 0.57-0.96]; 0.71 [0.54-0.95]; 0.64 [0.49-0.83]) and 3-point MACE (GLP-1ra vs. DPP-4i, SU, and insulin: 0.55 [0.35-0.86]; 0.71 [0.44-1.15]; 0.46 [0.28-0.76]). In patients without CVD history, using GLP-1ra yielded a greater risk reduction in both CVD outcomes.
Conclusion: In real-world clinical practice, using GLP-1ra vs. other 3 major classes of GLA in Taiwanese T2DM patients showed CVD benefits, especially in those without CVD history.
C. Yang: None. C. Yang: None. S. Kuo: None. H. Ou: None.
National Institute of Diabetes and Digestive and Kidney Diseases (P30DK092926)
