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Time-dependent effect of GLP-1 receptor agonists on cardiovascular benefits: a real-world study
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Time-dependent effect of GLP-1 receptor agonists on cardiovascular benefits: a real-world study
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Journal Article
Time-dependent effect of GLP-1 receptor agonists on cardiovascular benefits: a real-world study
2023
Overview
Background
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have shown cardiovascular benefits in cardiovascular outcome trials in type 2 diabetes mellitus. However, the most convincing evidence was obtained in subjects with established cardiovascular (CV) disease. We analyzed the determinants of GLP-1 RA-mediated CV protection in a real-world population of persons with type 2 diabetes with and without a history of CV events with long-term follow-up.
Methods
Retrospective cohort study of 550 individuals with type 2 diabetes (395 in primary CV prevention, 155 in secondary CV prevention), followed at a single center after the first prescription of a GLP-1 RA between 2009 and 2019. CV and metabolic outcomes were assessed.
Results
Median duration of follow-up was 5.0 years (0.25–10.8) in primary prevention and 3.6 years (0–10.3) in secondary prevention, with a median duration of treatment of 3.2 years (0–10.8) and 2.5 years (0–10.3) respectively. In the multivariable Cox regression model considering GLP-1 RA treatment as a time-dependent covariate, in the primary prevention group, changes in BMI and glycated hemoglobin did not have an impact on MACE risk, while age at the time of GLP-1 initiation (HR 1.08, 95% CI 1.03–1.14,
p
= 0.001) and GLP-1 RA cessation by time (HR 3.40, 95% CI 1.82–6.32,
p
< 0.001) increased the risk of MACE. Regarding the secondary prevention group, only GLP-1 RA cessation by time (HR 2.71, 95% CI 1.46–5.01,
p
= 0.002) increased the risk of MACE. With respect to those who withdrew treatment, subjects who continued the GLP-1 RA had significantly greater weight loss and lower glycated hemoglobin levels during follow-up.
Conclusions
In this real-world type 2 diabetes population, discontinuation of GLP-1 RA treatment was associated to a higher risk of major cardiovascular events, in both subjects with and without a history of CV events.
Publisher
BioMed Central,Springer Nature B.V,BMC
Subject
/ Cardiovascular Diseases - diagnosis
/ Cardiovascular Diseases - epidemiology
/ Cardiovascular Diseases - prevention & control
/ Diabetes
/ Diabetes mellitus (non-insulin dependent)
/ Diabetes Mellitus, Type 2 - diagnosis
/ Diabetes Mellitus, Type 2 - drug therapy
/ Diabetes Mellitus, Type 2 - epidemiology
/ Glucagon
/ Glucagon-Like Peptide-1 Receptor - agonists
/ Glucose
/ Humans
/ Ischemia
/ Medicine
/ Novel Cardioprotective Antidiabetic Medications
/ Patients
/ Stroke
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