医学
狼牙棒
内科学
2型糖尿病
心力衰竭
危险系数
人口
心房颤动
心脏病学
糖尿病
心肌梗塞
内分泌学
经皮冠状动脉介入治疗
环境卫生
置信区间
作者
Ana Palanca,Francisco Javier Ampudia‐Blasco,José Miguel Calderón,Inmaculada Saurí,Sergio Martínez-Hervás,José Luís Trillo,Josep Redón,José T. Real
标识
DOI:10.1016/j.diabres.2023.111071
摘要
Abstract
Aims
Assess the impact of glucagon-like peptide receptor agonists (GLP-1RA) compared to other glucose-lowering agents on cardiovascular outcomes in individuals with type 2 diabetes and obesity in a Spanish metropolitan area. Methods
A retrospective population-based type 2 diabetes cohort was identified from the Valencia Clinic-Malvarrosa Department electronic databases (2014–2019). Study groups included GLP-1RA, sodium-glucose co-transporter-2 inhibitors (SGLT2i), Insulin, and Miscellany (other glucose-lowering agents). 1:1:1:1 propensity score matching was conducted. The primary outcome was a composite of major adverse cardiovascular events (4-point MACE) comprising myocardial infarction, stroke, all-cause mortality, and heart failure. Secondary outcomes included individual 4-point MACE components. Hazard ratios were estimated using Cox regression analyses against the Miscellany group. Results
From 26,944 subjects, 1,848 adults were selected per group. GLP-1RA did not show a significant reduction in 4-point MACE risk (HR 1.05 [95%CI 0.82–1.34]). SGLT2i significantly reduced the risk of heart failure (HR 0.16 [95%CI 0.05–0.54]) and atrial fibrillation (HR 0.58, [95%CI 0.35–0.95]). The Insulin group exhibited a higher risk for 4-point MACE and most individual outcomes compared to GLP-1RA and SGLT2i. Conclusions
Our findings do not provide evidence of a reduced cardiovascular risk, as assessed by 4-point MACE, with GLP-1RA. In contrast, SGLT2i demonstrated protective effects against heart failure and atrial fibrillation.
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