GLP-1 Use and Risk of Cardiovascular Events in Different Patient Populations

Glucagon-like peptide-1 receptor agonists (GLP-1s) have proven to be effective at improving glycemic control in patients with type 2 diabetes and reducing body weight in individuals with obesity or overweight. However, more recent research has also shown that this class of drugs can improve cardiovascular outcomes, including reducing the rates of non-fatal myocardial infarction, non-fatal stroke and cardiovascular death.¹

GLP-1 Use and Risk of Cardiovascular Events in Different Patient Populations / K KStock - stock.adobe.com

At the American Diabetes Association 84th Scientific Sessions, held June 21 to 24 in Orlando, Florida, 3 posters examined GLP-1 use and cardiovascular disease risk in several different patient populations, including individuals with atherosclerotic cardiovascular disease, low to moderate risk of cardiovascular disease, and advanced chronic kidney disease.

READ MORE: Examining the Role of Remote CGM in Diabetes Management

In the first poster, investigators conducted a study to evaluate predictors of prescriptions of GLP-1s or sodium-glucose cotransporter-2 (SGLT2) inhibitors in patients with type 2 diabetes and atherosclerotic cardiovascular disease who were eligible for either medication.² Data on lab and imaging results, ICD9/10 diagnoses, prescriptions, provider and clinic characteristics, and demographics were gathered from electronic health records from a large academic health system.

The study cohort included 315 patients who were seen either in a primary care, endocrinology, cardiology, or nephrology clinic between January 2019 and August 2023. Of the patients, 142 were prescribed a GLP1 and 173 were prescribed a SGLT2i. Investigators found that having a lower BMI and being an established patient was associated with SGLT2i use. Patients who were treated in a cardiology clinic were more likely to be prescribed an SGLT2i, while patients treated in an endocrinology clinic were more likely to be prescribed a GLP-1.

“In a real-world dataset from a large academic center, the selection of guideline directed therapy for patients with T2D and ASCVD was strongly determined by the provider’s specialty, highlighting an important opportunity for education,” the authors concluded.

In the second poster, investigators conducted a study to examine the association between GLP-1 initiation and the risk of pancreatitis or biliary disease among patients with type 2 diabetes at low-to-moderate risk for cardiovascular disease.³ Data for the study was gathered from Medicare and 2 private health plans. Patients who initiated a GLP-1, dipeptidyl peptidase-4 inhibitor (DPP4i), or SGLT2i between 2013 and 2023 were included.

Investigators found that over 11 months of follow-up, the hazard ratio for pancreatitis among the GLP-1 group was 1.19 compared to the DPP4i group, and 0.99 compared to the SGLT2i group. For biliary disease, the hazard ratio in the GLP-1 group was 1.10 compared to the DPP4i group and 1.12 compared to the SGLT2i group.

“GLP-1 initiation was not associated with meaningful differences in the risk of acute pancreatitis or biliary disease in patients with type 2 diabetes and low-to-moderate cardiovascular risk,” the authors concluded.

In the third poster, investigators conducted a study to compare outcomes after the initiation of GLP-1s compared to DPP4i in patients with diabetes and advanced chronic kidney disease.⁴ Data for the retrospective cohort study was gathered from the Veterans Health Administration during fiscal years 2006 to 2021. The primary outcome was acute healthcare utilization and secondary outcomes included all-cause mortality and acute cardiovascular events.

The study cohort included 26997 patients who used GLP-1s and 37708 patients who used DPP4is. Patients were included in the study if they were US veterans aged 35 years or older and had advanced chronic kidney disease. Over a mean of 2.2 years of follow-up, GLP-1 use was associated with lower annual rates of acute healthcare utilization and lower all-cause mortality. However, there were no significant differences in cardiovascular events between the 2 groups.

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References

1. Ussher JR, Drucker DJ. Glucagon-like peptide 1 receptor agonists: cardiovascular benefits and mechanisms of action. Nat Rev Cardiol. 2023 Jul;20(7):463-474. doi: 10.1038/s41569-023-00849-3. Epub 2023 Mar 28. PMID: 36977782.

2. Agarwal S, Basit MA, Bowen ME, et al. Predictors of Selection of a GLP1RA vs. SGLT2i in People with Type 2 Diabetes and Atherosclerotic Cardiovascular Disease. Presented at: American Diabetes Association 84th Scientific Sessions; June 21-24, 2024; Orlando, FL. Abstract 777-P.

3. Paik JM, Tesfaye H, Cromer SJ, et al. GLP1RA Use and Risk of Pancreatitis and Biliary Disease in Adults with Type 2 Diabetes and Low to Moderate CV Risk. Presented at: American Diabetes Association 84th Scientific Sessions; June 21-24, 2024; Orlando, FL. Abstract 772-P.

4. Zhang S, Sidra F, Alvarez CA, et al. Acute Healthcare Utilization, Mortality, and Cardiovascular Events following GLP-1-RA Initiation by Patients with Advanced Chronic Kidney Disease—A Real-World Comparative Study. Presented at: American Diabetes Association 84th Scientific Sessions; June 21-24, 2024; Orlando, FL. Abstract 737-P.