Cardiovascular benefits of liraglutide in type 2 diabetes apply to high-risk subgroups
medwireNews: The cardioprotective effects of liraglutide apply to patients with chronic kidney disease (CKD) as well as those with established cardiovascular disease, show two post-hoc analyses of the LEADER trial.
By contrast, the drug did not appear to reduce the short-term risk for major adverse cardiovascular events (MACE) in people with type 2 diabetes who only have cardiovascular risk factors.
In the first of two subanalyses published in Circulation, Johannes Mann (Friedrich Alexander University of Erlangen, Germany) and colleagues found that liraglutide was associated with a significant 31% reduced risk for MACE compared with placebo among individuals with a baseline estimated glomerular filtration rate (eGFR) below 60 mL/min per 1.73 m2 (n=2158).
This was significantly greater than the nonsignificant 6% reduction observed among individuals with a baseline eGFR at or above 60 mL/min per 1.73 m2 (n=7182).
Similar results were observed for each of the individual cardiovascular outcomes, namely cardiovascular death, nonfatal myocardial infarction (MI), and nonfatal stroke, as well as all-cause mortality.
But there was no difference in the liraglutide-associated risk reduction in MACE between individuals with and without baseline albuminuria (hazard ratios [HRs]=0.83 vs 0.92).
Mann et al say their data show that the results of the LEADER trial “apply to patients with CKD, which is clinically important given that those patients with type 2 diabetes and CKD have a high [cardiovascular] risk burden and few options for antihyperglycemic therapies.”
In the second analysis, Steven Marso (HCA Midwest Health Heart & Vascular Institute, Kansas City, Missouri, USA) and team found that, compared with placebo, liraglutide reduced the risk for MACE by a significant 15% in patients with a history of MI/stroke (n=3692) and by a significant 24% in those with established atherosclerotic cardiovascular disease without MI/stroke (n=3083).
Conversely, the effect was neutral in patients who only had cardiovascular risk factors ie, isolated CKD, hypertension with left ventricular hypertrophy, New York Heart Association class II or III heart failure, and left ventricular systolic or diastolic dysfunction (n=2565).
“Taken together, these data indicate that the cardiovascular benefits of liraglutide are observed across a clinically relevant continuum of risk in [type 2 diabetes] with atherosclerosis or prior ischemic events,” Marso and co-authors remark.
They add: “The lack of apparent cardiovascular benefit in patients with [type 2 diabetes] and cardiovascular risk factors alone may suggest either a threshold effect, or that a longer duration of therapy is required to demonstrate cardiovascular efficacy.”
However, Marso et al point out that “all patients with [type 2 diabetes] irrespective of risk group benefit from liraglutide treatment in regard to reduced renal outcomes, improved glycemic control, weight reductions, and better blood pressure control.”
By Laura Cowen
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