ENDO: Fewer Cardiovascular Events With GLP1-RA, SGLT-2i for T2D, Liver Disease

A recent study presented at the annual meeting of the Endocrine Society, held from June 1 to 4 in Boston, has demonstrated that glucagon-like peptide 1 receptor agonists (GLP-1 RA) and sodium-glucose cotransporter 2 inhibitors (SGLT-2i) significantly reduce the risk of cardiovascular (CV) events in adults suffering from type 2 diabetes (T2D) and metabolic dysfunction-associated steatotic liver disease (MASLD). The findings suggest that these medications are more effective in preventing heart-related incidents compared to dipeptidyl peptidase 4 inhibitors (DPP-4i).

The research was led by Dr. Alexander Kutz from Brigham and Women's Hospital and Harvard Medical School in Boston. The team utilized pooled data from Medicare fee-for-service and a large U.S. health insurance database to evaluate the comparative cardiovascular and hepatic safety and effectiveness of GLP-1 RA and SGLT-2i in individuals diagnosed with T2D and MASLD.

The study revealed that for the primary cardiovascular outcome, the hazard ratio (HR) for GLP-1 RA was 0.67 compared to DPP-4i. This corresponds to an incidence rate difference (IRD) of -21.6 per 1,000 person-years among 13,666 initiators of GLP-1 RA and 17,084 initiators of DPP-4i. Regarding the primary hepatic outcome, the HR was 0.47, and the IRD was -2.1, indicating a significant reduction in severe liver events for those on GLP-1 RA.

Similarly, SGLT-2i also demonstrated cardiovascular benefits. Compared to DPP-4i, SGLT-2i had a HR of 0.82 for the primary cardiovascular outcome and an IRD of -11.0 among 11,108 initiators of SGLT-2i and 16,979 initiators of DPP-4i. However, the primary hepatic outcome for SGLT-2i was not significantly different from that of DPP-4i.

Importantly, the study also found that severe adverse events were not more frequent with GLP-1 RA or SGLT-2i compared to DPP-4i, indicating a favorable safety profile for these medications.

"Our study shows that GLP-1 receptor agonists and SGLT-2 inhibitors are more beneficial in preventing heart-related events compared to another group of drugs such as dipeptidyl peptidase 4 inhibitors, and GLP-1s also help reduce severe liver events," stated Dr. Kutz.

In summary, the findings underscore the potential benefits of GLP-1 RA and SGLT-2i in reducing cardiovascular risks and severe liver conditions in patients with T2D and MASLD. These insights could inform clinical decisions and improve patient outcomes by guiding the choice of medication for managing these conditions.