Comparative cardiovascular safety of GLP-1 receptor agonists versus other glucose-lowering agents in real-world patients with type 2 diabetes: a nationwide population-based cohort study

Abstract Background Current evidence about the cardiovascular safety of glucagon-like peptide-1 receptor agonist (GLP-1ra) possesses limited generalizability to real-world patients with type 2 diabetes (T2D) in usual practice. This study aimed to investigate the comparative cardiovascular safety of...

Full description

Bibliographic Details
Main Authors: Chun-Ting Yang, Chen-Yi Yang, Huang-Tz Ou, Shihchen Kuo
Format: Article
Language:English
Published: BMC 2020-06-01
Series:Cardiovascular Diabetology
Subjects:
Online Access:http://link.springer.com/article/10.1186/s12933-020-01053-0
_version_ 1819026210198388736
author Chun-Ting Yang
Chen-Yi Yang
Huang-Tz Ou
Shihchen Kuo
author_facet Chun-Ting Yang
Chen-Yi Yang
Huang-Tz Ou
Shihchen Kuo
author_sort Chun-Ting Yang
collection DOAJ
description Abstract Background Current evidence about the cardiovascular safety of glucagon-like peptide-1 receptor agonist (GLP-1ra) possesses limited generalizability to real-world patients with type 2 diabetes (T2D) in usual practice. This study aimed to investigate the comparative cardiovascular safety of GLP-1ra in comparisons with dipeptidyl peptidase-4 inhibitor (DPP-4i), sulfonylurea (SU), and insulin in a real-world population with T2D. Methods Adults with newly-diagnosed T2D were identified from Taiwan’s National Health Insurance Research Database in 2003–2014. A prevalent new-user cohort design was adopted to include a broad representation of real-world T2D patients being treated with GLP-1ra. The between-group comparability of baseline patient characteristics was achieved by matching on (1) initiation time of study drugs, (2) prior exposure to glucose-lowering agents, and (3) diabetes severity and complications, comorbidities, and concomitant cardiovascular medications using propensity scores. The primary outcome was a composite of cardiovascular disease (CVD) events and assessed up to the end of 2015. Cox modeling was employed to assess the association between study drugs and outcomes. Results A total of 3195 GLP-1ra stable users was identified in 2011-2014. 1893, 1829, and 1367 GLP-1ra stable users were 1:1 matched to DPP-4i, SU and insulin users, respectively. Compared to DPP-4i, SU and insulin, the use of GLP-1ra was associated with a lower risk of composite CVD events [hazard ratio (95% confidence interval) 0.73 (0.57–0.96), 0.76 (0.57–1.00), and 0.81 (0.62–1.07), respectively]. Subgroup analyses revealed that GLP-1ra versus DPP-4i yielded a greater cardiovascular benefit in those without established CVD versus those with established CVD. Conclusions This comparison study extends the supporting evidence for the cardiovascular safety of GLP-1ra to a broad spectrum of real-world T2D patients using GLP-1ra.
first_indexed 2024-12-21T05:22:57Z
format Article
id doaj.art-630936a616004863b2b0e38d742cad14
institution Directory Open Access Journal
issn 1475-2840
language English
last_indexed 2024-12-21T05:22:57Z
publishDate 2020-06-01
publisher BMC
record_format Article
series Cardiovascular Diabetology
spelling doaj.art-630936a616004863b2b0e38d742cad142022-12-21T19:14:46ZengBMCCardiovascular Diabetology1475-28402020-06-0119111010.1186/s12933-020-01053-0Comparative cardiovascular safety of GLP-1 receptor agonists versus other glucose-lowering agents in real-world patients with type 2 diabetes: a nationwide population-based cohort studyChun-Ting Yang0Chen-Yi Yang1Huang-Tz Ou2Shihchen Kuo3Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung UniversityInstitute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung UniversityInstitute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung UniversityDivision of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan Medical SchoolAbstract Background Current evidence about the cardiovascular safety of glucagon-like peptide-1 receptor agonist (GLP-1ra) possesses limited generalizability to real-world patients with type 2 diabetes (T2D) in usual practice. This study aimed to investigate the comparative cardiovascular safety of GLP-1ra in comparisons with dipeptidyl peptidase-4 inhibitor (DPP-4i), sulfonylurea (SU), and insulin in a real-world population with T2D. Methods Adults with newly-diagnosed T2D were identified from Taiwan’s National Health Insurance Research Database in 2003–2014. A prevalent new-user cohort design was adopted to include a broad representation of real-world T2D patients being treated with GLP-1ra. The between-group comparability of baseline patient characteristics was achieved by matching on (1) initiation time of study drugs, (2) prior exposure to glucose-lowering agents, and (3) diabetes severity and complications, comorbidities, and concomitant cardiovascular medications using propensity scores. The primary outcome was a composite of cardiovascular disease (CVD) events and assessed up to the end of 2015. Cox modeling was employed to assess the association between study drugs and outcomes. Results A total of 3195 GLP-1ra stable users was identified in 2011-2014. 1893, 1829, and 1367 GLP-1ra stable users were 1:1 matched to DPP-4i, SU and insulin users, respectively. Compared to DPP-4i, SU and insulin, the use of GLP-1ra was associated with a lower risk of composite CVD events [hazard ratio (95% confidence interval) 0.73 (0.57–0.96), 0.76 (0.57–1.00), and 0.81 (0.62–1.07), respectively]. Subgroup analyses revealed that GLP-1ra versus DPP-4i yielded a greater cardiovascular benefit in those without established CVD versus those with established CVD. Conclusions This comparison study extends the supporting evidence for the cardiovascular safety of GLP-1ra to a broad spectrum of real-world T2D patients using GLP-1ra.http://link.springer.com/article/10.1186/s12933-020-01053-0GLP-1 receptor agonistCardiovascular safetyDPP-4 inhibitorSulfonylureaInsulin
spellingShingle Chun-Ting Yang
Chen-Yi Yang
Huang-Tz Ou
Shihchen Kuo
Comparative cardiovascular safety of GLP-1 receptor agonists versus other glucose-lowering agents in real-world patients with type 2 diabetes: a nationwide population-based cohort study
Cardiovascular Diabetology
GLP-1 receptor agonist
Cardiovascular safety
DPP-4 inhibitor
Sulfonylurea
Insulin
title Comparative cardiovascular safety of GLP-1 receptor agonists versus other glucose-lowering agents in real-world patients with type 2 diabetes: a nationwide population-based cohort study
title_full Comparative cardiovascular safety of GLP-1 receptor agonists versus other glucose-lowering agents in real-world patients with type 2 diabetes: a nationwide population-based cohort study
title_fullStr Comparative cardiovascular safety of GLP-1 receptor agonists versus other glucose-lowering agents in real-world patients with type 2 diabetes: a nationwide population-based cohort study
title_full_unstemmed Comparative cardiovascular safety of GLP-1 receptor agonists versus other glucose-lowering agents in real-world patients with type 2 diabetes: a nationwide population-based cohort study
title_short Comparative cardiovascular safety of GLP-1 receptor agonists versus other glucose-lowering agents in real-world patients with type 2 diabetes: a nationwide population-based cohort study
title_sort comparative cardiovascular safety of glp 1 receptor agonists versus other glucose lowering agents in real world patients with type 2 diabetes a nationwide population based cohort study
topic GLP-1 receptor agonist
Cardiovascular safety
DPP-4 inhibitor
Sulfonylurea
Insulin
url http://link.springer.com/article/10.1186/s12933-020-01053-0
work_keys_str_mv AT chuntingyang comparativecardiovascularsafetyofglp1receptoragonistsversusotherglucoseloweringagentsinrealworldpatientswithtype2diabetesanationwidepopulationbasedcohortstudy
AT chenyiyang comparativecardiovascularsafetyofglp1receptoragonistsversusotherglucoseloweringagentsinrealworldpatientswithtype2diabetesanationwidepopulationbasedcohortstudy
AT huangtzou comparativecardiovascularsafetyofglp1receptoragonistsversusotherglucoseloweringagentsinrealworldpatientswithtype2diabetesanationwidepopulationbasedcohortstudy
AT shihchenkuo comparativecardiovascularsafetyofglp1receptoragonistsversusotherglucoseloweringagentsinrealworldpatientswithtype2diabetesanationwidepopulationbasedcohortstudy