Combined therapy with SGLT2i and GLP-1ra improves cardiovascular prognosis in a population with diabetes and overweigh or obesity. A real-world clinical practice study

Abstract Background Prior clinical trials found diabetic patients treated with SGLT2i and/or GLP1ra had lower rates of cardiovascular complications. Purpose This study (CardioCHUS-T2D) sought to determine the association between initiation of SGLT2i, GLP1ra or both, and major cardiovascular complications or death in high risk diabetic patients. Materials and methods The CardioCHUS-T2D study was an observational study in which adults with type 2 diabetes, older than 65 years old and overweight or obesity were identified in a Galician health area. Patients prescribed an SGLT2i, GLP1ra or both over the last 5 years were matched base on antidiabetic treatment, duration of treatment, sex, age, diabetes duration, arterial hypertension, hyperlipidemia, CAD, HF, atrial fibrillation, CVA and peripheral artery disease (PAD) and were included on a regression Cox for determining the main variables associated with outcomes. After score matching, we selected 5132 patients who were taking SGLT2i, GLP-1ra or both. The data records were obtained from shared electronic patient dossier (EPD). Patients were classified in 3 groups according antidiabetic drugs, SGLT2i or/and GLP-1ra. During follow-up, after treatment intake, the main outcomes were recorded (hospitalization for coronary artery disease (CAD), heart failure (HF) or cerebrovascular accident (CVA) events, overall and cardiovascular death. Results The main clinical characteristics of patients regarding antidiabetic treatment are represented on table 1. No clinical relevant differences were observed between the group of patients treated with any of the monotherapies (SGLT2i or GLP-1ra) and the patients treated with the combined therapy. During the period of observation, the group of patients receiving the combined therapy (SGLT2 + GLP-1ra) were associated with a significant reduction in the risk of suffering heart failure (HF) events (composite of HF hospitalization and HF-related death): HR: 0,651 (95%CI: 0,457-0,927; p=0,017), and all-cause mortality (HR: 0,602 (95%CI:0,443-0,817; p=0,001) (Figure 1) without significative differences in cerebrovascular events. Conclusions In a real-world practice observational study (CardioCHUS-T2D) combined therapy with SGLT2i + GLP1ra in patients with T2D older than 65 years with overweight or obesity was associated with a significative reduction in major cardiovascular complications.Clinical characteristics of patientsKaplan-Meier curves