Real-world evidence of "cardiovascular benefits"! SGLT-2i/GLP-1RA significantly reduces the risk of all-cause mortality after myocardial infarction 2022EASD

Introduction: Real-world studies have found that for patients with type 2 diabetes combined with first myocardial infarction, the use of SGLT-2i and GLP-1RA is associated with a significant reduction in the risk of 5-year all-cause mortality, and the benefits of the combination of the two are greater!

From September 19 to 23, 2022, the European Association for the Study of Diabetes 2022 Annual Conference, a major international conference in the field of endocrinology, was held
in Stockholm, Sweden in the form of "online + offline".
At the meeting, scholars shared a study entitled
"SGLT-2i and GLP-1 RA have a low correlation with the mortality of type 2 diabetes and first myocardial infarction in young patients between 2016 and 2020".

Clinical studies: SGLT-2i and GLP1-RA showed cardiovascular benefit

Type 2 diabetes is an important risk factor
for cardiovascular disease and death.
In people with type 2 diabetes and higher risk of cardiovascular disease, several large randomized controlled trials have found a reduction
in cardiovascular mortality and non-fatal cardiovascular complications following initiation of sodium-glucose cotransporter-2 inhibitors (SGLT-2i) and glucagon-like peptide-1 receptor agonists (GLP1-RA).

Although the first data were released in 2015, the proportion of people at high cardiovascular risk using these drugs has been low
.
The purpose of this study was to assess the effect of
prescription SGLT-2i and/or GLP1-RA on all-cause mortality from first myocardial infarction in people under 70 years of age with type 2 diabetes.

Clinical: SGLT-2i/GLP-1RA significantly reduces the risk of all-cause mortality after myocardial infarction

This study is a population-based observational cohort study of people with type 2 diabetes who were first diagnosed with myocardial infarction between the ages of 40 and 69 years, with data from the Swedish National Registry between January 2016 and December 2020
.
These people with type 2 diabetes were diagnosed in the National Drug Prescription Registry and defined as having been prescribed antidiabetic medication
at least twice.
Register prescriptions and collection dates
for antidiabetic and antihypertensive medications.
Data on comorbidities and cardiovascular events were collected from the National Patient Registry, which contains national discharge information
since 1987.
Information on the time of death was retrieved from the Swedish Coroner's Register of Deaths, grouped
according to whether patients used SGLT-2i, GLP1-RA or did not use these drugs.
The primary endpoint all-cause mortality was represented by a Kaplan-Meier curve, and statistical differences were assessed
using a Log-Rank test.

Of the 9,117 patients under 70 years of age diagnosed with type 2 diabetes and first myocardial infarction diagnosed between 2016 and 2020, 4584 (50.
3%) patients did not use either SGLT-2i or GLP-1RA, while 26.
8% took SGLT-2i, 9.
4% used GLP-1RA, and 13.
6% used both drugs
.
During the follow-up period (median 3 years), 1001 events (11.
0%)
occurred.
The five-year mortality rate is shown in Figure 1
.

As can be seen in the figure:

➤ Subjects who did not use SGLT-2i and GLP1-RA had the lowest 5-year survival rate, about 80%;

➤ Survival was significantly higher in the SGLT-2i or GLP1-RA group compared with the non-medication group (no SGLT-2i and GLP-1RA);

➤ Of the three groups, the 5-year survival rate was highest
in the SGLT-2i and GLP1-RA combination group.

Fig.
1 5-year survival rate of subjects in different drug groups

Summary of this article

This study showed that in younger people with diabetes and first-time myocardial infarction between 2016 and 2020, prescriptions for SGLT-2i or GLP1-RA were associated with
lower 5-year mortality.
The number of people using these drugs in high-risk patients still appears to be too low
.

Translator's introduction

Shen Liyan

Chief physician, master's degree, master tutor
.
Vice Chairman of the Endocrine Society of the 4th Qingdao Branch of the Chinese Medical Association, Member of the Standing Committee of the Diabetes Expert Committee and Diabetes Education Center of the Shandong Health Care Association, and Director of
the Qingdao Diabetes Prevention and Treatment Research Association.
He has been engaged in endocrinology clinical work for 30 years, and has successively studied
in the Department of Endocrinology of the Third Hospital of Beijing Medical University and the General Hospital of the People's Liberation Army.
In 2017, he was a visiting scholar
at the University of Michigan Hospital.
He is also an invited reviewer
of the Chinese Journal of Clinicians, Journal of Precision Medicine and Shandong Medicine of the Chinese Medical Association.
He has published more than 40 papers at home and abroad and at the provincial level
.
He has written many books and undertaken 3 city-level projects and 1 development zone project
.
He won the 2nd and 3rd prizes of Qingdao Science and Technology Progress Award respectively
.
Good at the prevention and treatment of diabetes and chronic complications, thyroid disease, adrenal gland related diseases, endocrine secondary hypertension screening, diagnosis and treatment; Diagnosis and treatment
of endocrine-related diseases such as osteoporosis, polycystic ovary syndrome, and gout.