AIMS
To examine the comparative effectiveness of glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium glucose cotransporter 2 inhibitors (SGLT2is) for select cardiovascular outcomes and to examine whether the relative risks varied across different patient subgroups in patients with type 2 diabetes.
MATERIALS AND METHODS
We conducted a nationwide cohort study of patients with type 2 diabetes who initiated GLP-1RAs or SGLT2is between 2012 and 2018 in Taiwan. The study outcomes included myocardial infarction and total stroke, further classified into ischemic or hemorrhagic stroke. We estimated the hazard ratios (HRs) and 95% confidence intervals (CIs) for each outcome comparing GLP-1RAs with SGLT2is using Cox proportional hazards models after 1:1 propensity score (PS) matching. We also examined if there was effect modification by age, underlying chronic kidney disease, or coexisting cardiovascular disease in pre-specified subgroup analyses.
RESULTS
Among 26,032 PS-matched patients, GLP-1RA initiators and SGLT2i initiators showed similar risks of myocardial infarction (HR, 0.99; 95% CI, 0.65-1.52), total stroke (0.90; 0.69-1.17), ischemic stroke (0.86; 0.65-1.14), and hemorrhagic stroke (0.88; 0.63-1.25). However, GLP-1RA treatment was associated with an increased risk of total stroke (1.76; 1.06-2.94) and ischemic stroke (1.88; 1.09-3.23) among patients with chronic kidney disease, but not among patients without chronic kidney disease. GLP-1RA therapy seemed to have a lower risk of hemorrhagic stroke among patients with cardiovascular disease (0.64; 0.43-0.97), but not in patients without cardiovascular disease.
CONCLUSIONS
GLP-1RAs and SGLT2is appeared to have comparable effectiveness on several cardiovascular outcomes overall but their comparative effectiveness may vary in certain patient subgroups. This article is protected by copyright. All rights reserved.