In a cohort of 1,421 patients with and type 2 diabetes, 36% of those treated with GLP-1RA died over 8.4 years compared to 52% in those not treated.
GLP-1RA treatment before STEMI is associated with lower long-term mortality, with a hazard ratio of 0.60.
Only 7% of the patients received GLP-1RA treatment prior to STEMI.
Patients on GLP-1RA were generally younger and had more comorbidities compared to those not treated.
No significant association was found between GLP-1RA and the occurrence of ischemic stroke, recurrent myocardial infarction, or hospitalization for heart failure.
Simplified
BACKGROUND: (GLP-1RA) treatment reduces cardiovascular events in type 2 diabetes. Yet, the impact of GLP-1RA treatment before (STEMI) on long-term prognosis in patients with type 2 diabetes remains unclear. In patients with STEMI and type 2 diabetes, we aimed to investigate the association between long-term prognosis and GLP-1RA treatment before STEMI.
METHODS: This nationwide cohort study included consecutive patients admitted with type 2 diabetes and STEMI in Denmark from 2010 to 2016. All data were retrieved from nationwide Danish registries. Type 2 diabetes was defined by prior hospital admission with type 2 diabetes or anti-diabetic prescriptions within one year before STEMI. Dispensed GLP-1RA medication was retrieved within one year before STEMI.
RESULTS: Of 1421 patients with STEMI and diabetes, 7% were treated with GLP-1RA before STEMI and 93% were not. Patients treated with GLP-1RA were younger, had more comorbidities, and more often treated with other anti-diabetics. During 8.4 years, 36% patients treated with GLP-1RA died whereas 52% died in the no GLP-1RA group (p = 0.002). In adjusted Cox analysis, GLP-1RA was associated with lower long-term mortality (hazard ratio (HR) 0.60, 95% confidence interval (CI) 0.43-0.84). There was no association between GLP-1RA and ischemic stroke (adjusted HR 1.05, 95% CI 0.57-1.94), recurrent myocardial infarction (adjusted HR 0.74, 95% CI 0.48-1.15), or hospitalisation for heart failure (adjusted HR 0.71, 95% CI 0.48-1.05).
CONCLUSIONS: In patients with diabetes and STEMI, GLP-1RA treatment prior to STEMI admission was associated with significantly lower long-term mortality.
Key numbers
0.60
Lower Long-term Mortality
Adjusted hazard ratio for all-cause mortality in GLP-1RA group vs. no GLP-1RA group.
36% vs. 52%
Mortality Rate Comparison
Mortality rates during 8.4 years follow-up for GLP-1RA vs. no GLP-1RA group.
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Declarations. Competing interests: The salary of JM. Madsen was supported by a grant from the Research Foundation of Rigshospitalet (E-22670–08). T. Engstrøm has received speaker fees from Abbott Vascular, Boston Scientific, and Bayer, an advisory board fee from Abbott, Novo Nordisk and partici-pated in Data Safety Monitoring of the INFINITY Trial, unrelated to this topic. J. Lønborg has received an advisory board fee, an unrestricted grant, and speakers fee from Boston Sci-entific and speakers fee from Abbott, unrelated to this topic. All other authors have no con-flicts of interest to disclose. L. Køber has received speaker’s honorarium from Novo Nordisk, Astra-Zeneca, Boehringer and Novartis. All other authors have nothing to declare. Ethics approval and consent for publication: All civil registration numbers were encrypted which enabled anonymity in all included patients. All register-based studies in an anonymous setup do not require ethical approval in Denmark. The authors are solely responsible for the design and conduct of this study, all analyses, drafting and editing of the paper and its final contents.
