Both SGLT2i inhibitors (SGLT2i) and GLP-1 receptor agonists (GLP-1 RA) have shown cardiovascular (CV) benefits in CV outcome trials among patients with type 2 diabetes (T2D) and established CV disease (CVD). Whether these agents are associated with differential CV effects and mortality in real-world T2D patients with and without CVD is unclear. Using Medicare and 2 U.S. commercial claims datasets (4/2013-12/2016), we identified 1:1 propensity score-matched patients aged ≥18 years with T2D initiating a SGLT2i or a GLP-1 RA with and without CVD (32,064 and 101,210 matched pairs, respectively). We assessed a composite CV outcome [myocardial infarction (MI) or stroke], mortality, and hospitalization for heart failure (HHF), and estimated hazard ratios (HRs) and 95% CIs adjusting for >140 baseline covariates. Compared to GLP-1 RA, the HR for the composite CV outcome was 1.10 (95% CI 0.95-1.26) for SGLT2i initiators with CVD, and 1.23 (1.08-1.41) for initiators without CVD, over a mean 8.4-month follow-up (Table). Initiators of the two drugs with and without CVD had similar mortality risk, but SGLT2i users had 31-33% reductions in HHF risk [0.67 (0.55-0.81) and 0.69 (0.51-0.92)]. This study suggests robust reductions in rates of HHF associated with SGLT2i vs. GLP-1, but in primary prevention, where HHF was less common, benefits were offset by somewhat increased risk of MI and stroke.
E. Patorno: Research Support; Self; National Institute on Aging. Other Relationship; Self; Boehringer Ingelheim International GmbH. A. Pawar: None. S. Schneeweiss: Consultant; Self; Aetion, WHISCON, LLC. R.J. Glynn: Research Support; Self; AstraZeneca, Kowa Pharmaceutical Europe Co. Ltd., Novartis Pharmaceuticals Corporation, Pfizer Inc. D.H. Kim: None. B.M. Everett: Advisory Panel; Self; American College of Cardiology. Consultant; Self; Abbott Laboratories, Amgen Inc., National Institute of Diabetes and Digestive and Kidney Diseases, Novartis Pharmaceuticals Corporation, Roche Diagnostic USA. Research Support; Self; Novartis Pharmaceuticals Corporation. Other Relationship; Spouse/Partner; Merck & Co., Inc. Other Relationship; Self; UpToDate. Other Relationship; Spouse/Partner; UpToDate. L.G. Bessette: None. S.C. Kim: Research Support; Self; Bristol-Myers Squibb Company, Genentech, Inc., Pfizer Inc.
