GLP-1 Agonists Come Out on Top in Cardiovascular Comparison of Newer Diabetes Meds

9 May 2023 • A recent study published in the Annals of Internal Medicine aimed to test the hypothesis that MACE(Major adverse cardiovascular events) incidence was lower with the addition of GLP1RA or SGLT2i compared with dipeptidyl peptidase-4 inhibitors (DPP4i) for primary cardiovascular prevention.

WHAT IS ALREADY KNOWN ON THIS TOPIC The effectiveness of glucagon-like peptide-1 receptor agonists (GLP1RA) and sodium–glucose cotransporter-2 inhibitors (SGLT2i) in preventing major adverse cardiac events (MACE) is uncertain for those without preexisting cardiovascular disease.


  • Study design : Retrospective cohort study of U.S. veterans from 2001 to 2019.
  • Patients : Veterans adding GLP1RA, SGLT2i, or DPP4i onto metformin, sulfonylurea, or insulin treatment alone or in combination.
  • The cohort included 28,759 GLP1RA versus 28, 628 DPP4i weighted pairs and 21,200 SGLT2i versus 21 ,70 DPP4i weighted pairs. Median age was 67 years, and diabetes duration was 8.5 years.
  • Conclusion : The addition of GLP1RA was associated with primary reductions of MACE and HF hospitalization compared with DPP4i use; SGLT2i addition was not associated with primary MACE prevention.
  • Limitation : Use of DPP4i, GLP1RA, and SGLT2i as first-line therapies were not examined.

HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY With such short follow-up severely limiting any head-to-head comparisons between GLP-1 agonists and SGLT-2 inhibitors, the study authors nevertheless suggested that at least the former may have a role in primary prevention in people with diabetes, regardless of heart disease history.

Source: Annals of Internal Medicine | Read full story

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