Association of glucagon‐like peptide‐1 receptor agonist use and rates of acute myocardial infarction, stroke and overall mortality in patients with type 2 diabetes mellitus in a large integrated health system

Apr 14, 2017Diabetes, obesity & metabolism

Use of GLP-1 receptor drugs linked to heart attack, stroke, and death rates in people with type 2 diabetes

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Abstract

Patients with type 2 diabetes exposed to glucagon-like peptide-1 receptor agonists (GLP-1RAs) experienced a 48% reduction in overall mortality.

GLP-1RA exposure was associated with lower rates of acute myocardial infarction (AMI) and stroke/cerebrovascular accident (CVA).
The hazard ratio for AMI was 0.80, indicating a reduced risk, while the hazard ratio for CVA was 0.82.
Overall mortality showed a significant decrease with a hazard ratio of 0.48 during GLP-1RA exposure.
The composite outcome of AMI, CVA, and mortality had a hazard ratio of 0.82, suggesting a similar reduction in risk.
The positive effects of GLP-1RAs were observed in patients both with and without prior cardiovascular disease.

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AIMS: To assess the potential impact of glucagon-like peptide-1 receptor agonist (GLP-1RA) exposure on cardiovascular disease (CVD) and mortality outcomes in patients with type 2 diabetes (T2D), using a large retrospective cohort.

RESEARCH DESIGN AND METHODS: Patients who had T2D between 2005 and 2014 (N = 105 862) were identified from the electronic health record system at Cleveland Clinic using a validated electronic phenotype. A time-dependent, Cox, multiple regression analysis was used to assess the association between GLP-1RA exposure and risk of acute myocardial infarction (AMI), stroke/cerebrovascular accident (CVA), and overall mortality, as well as the composite of all three outcomes. The findings were further evaluated by assessing the effect of GLP-1RAs on the same variables in patients with and without prior CVD. The model adjusted for differences in demographic information, hypertension, laboratory/vital signs, history of outcomes, and T2D medications.

RESULTS: There were significantly lower rates of AMI (hazard ratio [HR] 0.80, 95% confidence interval [CI] 0.65 to 0.99; P = .045), CVA (HR 0.82, 95% CI 0.74 to 0.91, P < .001), overall mortality (HR 0.48, 95% CI 0.41 to 0.57; P < .001), and the composite outcome (HR 0.82, 95% CI 0.74 to 0.91; P < .002) during the consolidated time that patients were exposed to GLP-1RAs compared to corresponding rates during intervals without GLP-1RA exposure. GLP-1RA treatment was associated with a significant decrease in CVA, mortality, and the composite outcome in patients with and without established CVD, not significantly affecting AMI in these subgroups.

CONCLUSIONS: GLP-1RA exposure was found to be associated with a reduction in the risk of cardiovascular events observed and overall mortality among patients with T2D with and without established CVD, after adjusting for potential confounders.

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Association of glucagon‐like peptide‐1 receptor agonist use and rates of acute myocardial infarction, stroke and overall mortality in patients with type 2 diabetes mellitus in a large integrated health system

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