BACKGROUND: The prevalence of diabetic cardiomyopathy (DiabCM) is increasing in parallel with diabetes mellitus, with no consensus on targeted treatment.
AIMS: This study aims to investigate the cardiovascular benefits of sodium-glucose cotransporter-2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) alone and combination on symptomatic DiabCM participants.
MATERIAL AND METHODS: This was a single-center prospective cohort study focusing on patients with symptomatic DiabCM. The study comprised 587 participants: 154 in the SGLT2is group, 105 in the GLP-1RAs group, 93 in the SGLT2is combined with GLP-1RAs group (SGLT2is + GLP-1RAs), and 235 in the control group (without SGLT2is or GLP-1RAs). All participants were followed for 36 months. The primary outcome was a composite of all-cause death and hospitalization for heart failure.
RESULTS: The incidence of endpoint event was lowest in the SGLT2is + GLP-1RAs group (23.7%), followed by the SGLT2is group (32.5%), GLP-1RAs group (39.0%), and control group (53.6%). Multivariable Cox regression analysis showed that SGLT2is (P <0.001), GLP-1RAs (P = 0.02) or SGLT2is + GLP-1RAs prescription (P <0.001) were independent protective factors for the occurrence of primary outcome. In subgroup analysis, SGLT2is or SGLT2is + GLP-1RAs treatment remained the independent factors for freedom from primary outcome in both heart failure with reduced ejection fraction + heart failure with mildly reduced ejection fraction and heart failure with preserved ejection fraction patients. However, GLP-1RAs alone did not exert clinical benefits in subgroup analysis.
CONCLUSIONS: SGLT2is and GLP-1RAs might reduce the incidence of all-cause mortality and heart failure hospitalization in patients with symptomatic DiabCM, and the combination of these two agents may further improve clinical outcomes.
