在中等基线心血管风险范围内，二线降糖治疗对成人2型糖尿病患者心血管影响的异质性

IF 5.3 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the American Heart Association Pub Date : 2025-07-17 DOI:10.1161/JAHA.124.040217

Yihong Deng, Eric C Polley, Jeph Herrin, Kavya S Swarna, David M Kent, Joseph S Ross, Bradley A Maron, Mindy M Mickelson, Rozalina G McCoy

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How these benefits vary across lower levels of cardiovascular risk is unknown.Methods: We used nationwide claims data to emulate a comparative effectiveness trial and examine the heterogeneity of treatment effects of GLP-1RAs, SGLT2is, DPP4is, and sulfonylureas on major adverse cardiovascular events (MACEs) among adults with type 2 diabetes and moderate cardiovascular risk (annualized MACE risk 1%-5%, estimated using the annualized claims-based MACE estimator).Results: Among 386 276 included adults with type 2 diabetes, 25.2% had baseline ACME-predicted MACE risk >1% to ≤2% (lower-risk patients) and 13.3% had ACME-predicted risk >4% to ≤5% (higher-risk patients). 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引用次数: 0

摘要

背景：与二肽基肽酶-4抑制剂（DPP4is）和磺脲类药物相比，胰高血糖素样肽-1受体激动剂（GLP-1RAs）和钠-葡萄糖共转运体-2抑制剂（SGLT2is）在成人2型糖尿病和心血管高风险患者中具有更好的心血管结局。这些益处在心血管风险较低的人群中如何变化尚不清楚。方法：我们使用全国范围内的索赔数据来模拟比较有效性试验，并检查GLP-1RAs、SGLT2is、DPP4is和磺脲类药物治疗2型糖尿病和中度心血管风险成人患者的主要不良心血管事件（MACE）治疗效果的异质性（MACE年化风险1%-5%，使用基于索赔的MACE年化估计器估计）。结果：在386 276例纳入的成人2型糖尿病患者中，25.2%的患者acme预测MACE基线风险>为1%至≤2%（低危患者），13.3%的患者acme预测风险>为4%至≤5%（高危患者）。在治疗的第3年，高风险患者比低风险患者获得了更大的绝对获益，当GLP-1RAs与磺酰脲类药物治疗时（MACE估计率在高风险患者中绝对降低3.1%，在低风险患者中绝对降低1.6%），SGLT2is与磺酰脲类药物相比（绝对降低，在高风险患者中绝对降低3.9%，在低风险患者中绝对降低1.3%），GLP-1RAs与DPP4is相比（绝对降低，在高风险患者中绝对降低1.6%，在低风险患者中绝对降低0.5%）。高风险SGLT2is患者与低风险DPP4is患者相比，MACE的相对获益也更大(高风险患者的危险比[HR]， 0.78 [95% CI, 0.70-0.87]；低危患者HR为0.99 [95% CI, 0.88-1.12])。相反，DPP4is和GLP-1RAs与磺脲类药物相比，在低危患者中获益更大：DPP4is与磺脲类药物相比，低危患者的HR为0.76 (95% CI, 0.71-0.81)，高危患者的HR为0.91 (95% CI, 0.97-0.96)；GLP-1RAs与磺脲类药物相比，低危患者的HR为0.67 (95% CI, 0.58-0.78)，高危患者的HR为0.80 （95% CI, 0.70-0.93）。SGLT2is和GLP-1RAs的益处在所有风险水平上都具有可比性。结论：SGLT2is和GLP-1RAs的心血管益处存在于所有中度心血管风险水平，这加强了在所有2型糖尿病患者中选择可以预防MACE的降糖治疗的重要性。

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Heterogeneity of Cardiovascular Effects of Second-Line Glucose-Lowering Therapies in Adults With Type 2 Diabetes Across the Range of Moderate Baseline Cardiovascular Risk.

Background: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT2is) have favorable cardiovascular outcomes compared with dipeptidyl peptidase-4 inhibitors (DPP4is) and sulfonylureas in adults with type 2 diabetes and high cardiovascular risk. How these benefits vary across lower levels of cardiovascular risk is unknown.

Methods: We used nationwide claims data to emulate a comparative effectiveness trial and examine the heterogeneity of treatment effects of GLP-1RAs, SGLT2is, DPP4is, and sulfonylureas on major adverse cardiovascular events (MACEs) among adults with type 2 diabetes and moderate cardiovascular risk (annualized MACE risk 1%-5%, estimated using the annualized claims-based MACE estimator).

Results: Among 386 276 included adults with type 2 diabetes, 25.2% had baseline ACME-predicted MACE risk >1% to ≤2% (lower-risk patients) and 13.3% had ACME-predicted risk >4% to ≤5% (higher-risk patients). By year 3 of treatment, higher-risk patients derived greater absolute benefit than lower-risk patients when treated with GLP-1RAs versus sulfonylureas (absolute reduction in the estimated rate of MACE of 3.1% in higher-risk patients and 1.6% in lower-risk patients), SGLT2is versus sulfonylureas (absolute reduction, 3.9% in higher-risk patients and 1.3% in lower-risk patients), and GLP-1RAs versus DPP4is (absolute reduction, 1.6% in higher-risk patients and 0.5% in lower-risk patients). The relative benefits for MACE were also greater in higher-risk than lower-risk patients with SGLT2is versus DPP4is (hazard ratio [HR], 0.78 [95% CI, 0.70-0.87] in higher-risk patients; HR, 0.99 [95% CI, 0.88-1.12] in lower-risk patients). Conversely, the relative benefits of DPP4is and GLP-1RAs versus sulfonylureas were greater in lower-risk patients: HR 0.76 (95% CI, 0.71-0.81) in lower-risk and HR 0.91 (95% CI, 0.97-0.96) in higher-risk patients for DPP4is versus sulfonylureas; HR 0.67 (95% CI, 0.58-0.78) in lower-risk and HR 0.80 (95% CI, 0.70-0.93) in higher-risk patients for GLP-1RAs versus sulfonylurea. Benefits of SGLT2is and GLP-1RAs were comparable across all risk levels.

Conclusions: Cardiovascular benefits of SGLT2is and GLP-1RAs exist across all levels of moderate cardiovascular risk, reinforcing the importance of choosing glucose-lowering therapies that can prevent MACE in all people with type 2 diabetes.

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来源期刊

Journal of the American Heart Association CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

9.40

自引率

1.90%

发文量

1749

审稿时长

12 weeks

期刊介绍： As an Open Access journal, JAHA - Journal of the American Heart Association is rapidly and freely available, accelerating the translation of strong science into effective practice. JAHA is an authoritative, peer-reviewed Open Access journal focusing on cardiovascular and cerebrovascular disease. JAHA provides a global forum for basic and clinical research and timely reviews on cardiovascular disease and stroke. As an Open Access journal, its content is free on publication to read, download, and share, accelerating the translation of strong science into effective practice.