Comparative effectiveness of SGLT2i versus GLP1-RA on cardiovascular outcomes in routine clinical practice

Jan 25, 2022International journal of cardiology

Heart health outcomes with SGLT2 inhibitors compared to GLP1 receptor agonists in everyday medical care

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Abstract

12,375 individuals were followed for a median of 1.6 years to compare cardiovascular outcomes of SGLT2 inhibitors and GLP1 receptor agonists.

SGLT2 inhibitors did not show a significant difference in major adverse cardiovascular events (MACE) risk compared to GLP1 receptor agonists, with an adjusted hazard ratio of 1.04.
The risk of hospitalization for heart failure was lower among SGLT2 inhibitor users, with an adjusted hazard ratio of 0.80.
No significant differences were found for cardiovascular death or myocardial infarction between the two medication classes.
SGLT2 inhibitors were associated with a higher risk of ischemic stroke, indicated by an adjusted hazard ratio of 1.71, with a 5-year absolute risk difference of 1.9%.

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BACKGROUND: To investigate the comparative effectiveness of sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP1-RA) on cardiovascular outcomes in routine clinical practice, which have never been directly compared in head-to-head outcome trials.

METHODS: We compared outcomes of adults who newly started SGLT2i or GLP1-RA therapy in Stockholm, Sweden, during 2013-2019. The primary outcome was major adverse cardiovascular events (MACE), a composite of cardiovascular (CV) death, myocardial infarction and stroke. Secondary outcomes included the individual MACE components and hospitalization for heart failure. Cox regression with propensity score overlap weighting was used to estimate hazard ratios (HRs) with 95% confidence intervals and adjust for 57 covariates.

RESULTS: We included 12,375 individuals, of which 5489 initiated SGLT2i and 6886 GLP1-RA therapy, followed for median 1.6 years. Mean age was 61 years and 37.6% were women. Compared with GLP1-RA, SGLT2i new users had similar risk of MACE risk (adjusted HR 1.04; 95% CI 0.83-1.31). The adjusted HRs (95% CI) for SGLT2i vs. GLP1-RA were 0.80 (0.59-1.09) for heart failure hospitalization, 0.95 (0.58-1.55) for cardiovascular death, 0.91 (0.67-1.24) for myocardial infarction and 1.71 (1.14-2.59) for ischemic stroke (5-year absolute risk difference for stroke 1.9% [95% CI 0.8-3.0]).

CONCLUSIONS: In a largely primary-prevention population of people undergoing routine care, no differences were observed in MACE risk among initiators of SGLT2i and GLP1-RA. However, compared with GLP1RA, the use of SGLT2i was associated with an increased risk of ischemic stroke that was small in absolute magnitude.

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Comparative effectiveness of SGLT2i versus GLP1-RA on cardiovascular outcomes in routine clinical practice

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