Journal of the American Heart Association

Varied Heart and Blood Vessel Effects of Second-Choice Diabetes Medicines in Adults with Moderate Heart Risk

Updated

Abstract

Among 386,276 adults with type 2 diabetes, 25.2% had a predicted major adverse cardiovascular event (MACE) risk of more than 1% to 2%.

  • Higher-risk patients experienced greater absolute reductions in MACE rates when treated with GLP-1 receptor agonists (3.1%) and sodium-glucose cotransporter-2 inhibitors (3.9%) compared to lower-risk patients (1.6% and 1.3%, respectively).
  • The relative benefits of SGLT2 inhibitors versus DPP-4 inhibitors were significantly better in higher-risk patients (hazard ratio 0.78) compared to lower-risk patients (hazard ratio 0.99).
  • Conversely, the relative benefits of DPP-4 inhibitors and GLP-1 receptor agonists compared to sulfonylureas were greater in lower-risk patients (hazard ratios of 0.76 and 0.67, respectively).
  • SGLT2 inhibitors and GLP-1 receptor agonists showed comparable cardiovascular benefits across all levels of moderate cardiovascular risk.

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Funding

Competing interests

In the past 36 months, Dr McCoy has received support from the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health, the National Institute on Aging of the National Institutes of Health, the National Center for Advancing Translational Sciences, and the American Diabetes Association for projects unrelated to this work. She also served as a consultant to Emmi (Wolters Kluwer) and Yale/New Haven Health System and has received speaking honoraria and travel support from the American Diabetes Association. Dr Herrin currently receives support from the Centers for Medicare and Medicaid Services to develop measures of quality and equity; the National Institutes of Health, Agency for Healthcare Research and Quality, the Patient‐Centered Outcomes Research Institute, and the American Heart Association for multiple research projects. Dr Ross currently receives research support through Yale University from Johnson and Johnson to develop methods of clinical trial data sharing, from the Food and Drug Administration for the Yale–Mayo Clinic Center for Excellence in Regulatory Science and Innovation program (U01FD005938), from the Agency for Healthcare Research and Quality (R01HS022882), and from Arnold Ventures; formerly received research support from the Medical Device Innovation Consortium as part of the National Evaluation System for Health Technology; and, in addition, Dr Ross was an expert witness at the request of Relator's attorneys, the Greene Law Firm, in a qui tam suit alleging violations of the False Claims Act and Anti‐Kickback Statute against Biogen Inc. that was settled September 2022. Other authors have no conflicts of interest to disclose.
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