Both SGLT2 inhibitors (canagliflozin and empagliflozin) and liraglutide have shown cardiovascular (CV) benefits in CV outcome trials. Whether these agents are associated with differential CV effects in routine care remains unexplored. In a large commercial U.S. health insurance database (4/2013-9/2015), we assessed the comparative CV risk of SGLT2 inhibitors (SGLT2i) vs. liraglutide in patients with type 2 diabetes. We used 1:1 propensity score (PS) matching to balance over 100 baseline characteristics. We estimated the hazard ratio (HR) of a combined CV outcome (hospitalization for myocardial infarction (MI) or stroke) and heart failure hospitalization (HHF). Secondary outcomes included an expanded combined CV outcome (hospitalization for MI, stroke, unstable angina, or coronary revascularization) and individual MI or stroke hospitalization. Over 30 months, SGLT2i initiators had no significant difference in the risk of the combined CV outcome (HR= 1.01 [95% CI 0.76-1.34]) or other secondary CV outcomes, but had an approximately 30% decrease in the risk of HHF (HR= 0.68 [0.52-0.88]), compared with liraglutide (Table). Subgroup analyses in patients with and without baseline CV disease produced largely consistent results.
In conclusion, this study rules out large differences in atherosclerotic CV risk between SGLT2i and liraglutide, but supports larger benefits of SGLT2i vs. liraglutide for HHF.
E. Patorno: Research Support; Self; National Institute on Aging. Other Relationship; Self; Boehringer Ingelheim GmbH, GlaxoSmithKline plc. B.M. Everett: Research Support; Self; Roche Diagnostics Corporation, Novartis Pharmaceuticals Corporation. Consultant; Self; Roche Diagnostics Corporation, Abbott Laboratories, Novartis Pharmaceuticals Corporation, U.S. Food and Drug Administration, UpToDate. Other Relationship; Self; American College of Cardiology. S. Schneeweiss: Consultant; Self; WHISCON, LLC. Other Relationship; Self; Aetion, Inc.. Research Support; Self; Genentech, Inc., Bayer AG, Boehringer Ingelheim GmbH, U.S. Food and Drug Administration, Patient-Centered Outcomes Research Institute. R.J. Glynn: Research Support; Self; Pfizer Inc., Novartis AG, Kowa Pharmaceuticals America, Inc.. J. Liu: None. S.C. Kim: None.