medwireNews: Age, duration of type 2 diabetes, and race may help guide choice of glucose-lowering therapy for individuals with a high risk for cardiovascular disease (CVD) or established CVD, say the authors of a systematic review and meta-analysis published in eClinicalMedicine.
They report that Asian people and those aged 75 years and older derived the greatest reduction in the likelihood of major adverse cardiovascular events (MACE) with glucagon-like peptide (GLP)-1 receptor agonists, whereas the greatest benefit with sodium-glucose cotransporter (SGLT)2 inhibitors was found for those with a diabetes duration of at least 10 years.
Alhassane Diallo (CHU Montpellier, France) and co-workers collated information for 96,580 individuals with type 2 diabetes who participated in 11 placebo-controlled, phase 3 trials of GLP-1 receptor agonists or SGLT2 inhibitors that reported cardiovascular outcomes.
The majority of participants were White (77.6%) men (64.2%), while 8.0% were Asian and 4.2% were Black; at baseline 46.3% of participants were taking insulin.
Overall, 5.0% of participants experienced a three-point MACE (CV death, nonfatal stroke, or myocardial infarction) and the use of GLP-1 receptor agonists or SGLT2 inhibitors in addition to standard care was associated with comparable reductions in the likelihood of MACE versus placebo (hazard ratio [HR]=0.87 and 0.91, respectively).
Meta-analysis of two SGLT2 inhibitor trials demonstrated that people with diabetes for 10 years or more were significantly less likely to experience MACE than those with a shorter duration (hazard ratio [HR]=0.84).
However, analysis of four SGLT2 inhibitor trials indicated that age did not affect MACE outcome and there was no difference in MACE outcomes between White, Asian, and Black individuals participating in three SGLT2 inhibitor studies.
By contrast, seven studies of GLP-1 receptor agonists pointed to a greater MACE benefit among Asian than White participants (HR=0.71 vs 0.87) and two studies suggested a reduction in MACE for individuals aged at least 75 years taking GLP-1 receptor agonists (HR=0.78) but no such benefit in younger participants.
“These findings could help in providing guidance for treatment prescriptions and facilitate selection and stratification of patients for future [cardiovascular outcomes trials],” Diallo et al write.
And they emphasize that “pooled individual patient-level data are urgently needed to support our conclusions and to derive definitive evidence.”
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