eClinicalMed: Age, sex, BMI, etc. of cardiovascular benefits in T2DM patients receiving SGLT2i and GLP-1 RA

Pooled data from cardiovascular prognosis trials of SGLT2i and GLP-1 receptor agonists suggest that these agents reduce major adverse cardiovascular events (MACEs)
in patients.
However, it is unclear whether older people, obese patients, or those with prolonged diabetes, or certain ethnic minorities (blacks) can also benefit from these treatments
.

The study aims to provide information by age (< 65 v>s 65 years and < 75 vs > 75 years), gender (male vs female), race (black vs white, black vs Asian, white vs Asian), body mass index (BMI< 30kg/m 2 vs ≥30kg/m² Overall hazard ratio estimates for MACE associated with SGLT2i and GLP-1 receptor agonists stratified by diabetes course (< 10 years versus ≥
10 years).

The investigators searched the MEDLINE database for all placebo-controlled phase 3 trials evaluating the efficacy of SGLT2i and GLP-1 receptor agonists in people with type 2 diabetes up to 31 July 2022, calculating the risk ratio (HR)
for MACE in specific risk groups.

Risk ratio stratified by age, sex, BMI

Eleven studies met the inclusion criteria, covering a total of 96,580 people with
T2D.
Of these patients, 61,975 (64.
2%) were male, 74,982 (77.
6%) were white, 7,760 (8.
0%) were Asian, and 4,023 (4.
2%) were black
.
In two SGLT2i trials, the HR (95% CI) for diabetes > 10 years versus 10 years < was 0.
84 (0.
77–0.
93) vs 1.
02 (0.
89–1.
16) (p=0.
03),
respectively.
In four SGLT2i trials, MACE benefits were similar
across gender, age, BMI and ethnicity.

Seven trials showed that the benefit of MACE in Asians treated with GLP-1 agonists tended to be greater than in whites (HR: 0.
71 vs 0.
87, p=0.
07).

In two GLP-1 agonist trials, MACE outcomes were reduced by 22% ≥ older patients aged 75 years, but no difference
was observed in people under 75 years of age.
No differences in MACE benefit were observed in
other risk groups (sex, duration of diabetes, ethnicity, BMI).

Overall, the benefit of MACE was particularly significant
in patients with type 2 diabetes who were at high risk of cardiovascular disease or who had established cardiovascular disease, as well as in Asian patients (compared with Caucasians) receiving GLP-1 agonists.

Original source:

Alhassane Diallo, et al.
Age, sex, race, BMI, and duration of diabetes differences in cardiovascular outcomes with glucose lowering drugs in type 2 diabetes: A systematic review and meta-analysis.
eClinicalMedicine.
October 12, 2022.
https://doi.
org/10.
1016/j.
eclinm.
2022.
101697