A recent study has discovered that in older veterans without prior heart disease, GLP1 receptor agonists, a class of diabetes medications, may be linked to fewer severe adverse heart disease events compared to DPP4 inhibitors, another kind of diabetes drug.
Published in the Annals of Internal Medicine, the findings will assist clinicians in determining the best diabetes drug regimen for older patients.
Diabetes and Heart Disease: A Noteworthy Relationship
Over 30 million adults in the U.S. have diabetes mellitus, increasing their risk of adverse cardiovascular events such as heart attack, stroke, cardiovascular death, and heart failure hospitalization.
The study aimed to address two significant knowledge gaps. Many newer diabetes drugs were tested against a placebo, making it challenging to discern if one type is superior to another.
Moreover, the clinical trials demonstrating the cardiovascular benefits of these drugs were conducted on individuals who already had heart disease.
GLP1 Receptor Agonists vs. DPP4 Inhibitors: Who Wins?
In a retrospective cohort study involving US veterans, the researchers discovered that adding a GLP1 receptor agonist reduced the risk of major adverse cardiovascular events (MACE) and heart failure hospitalization compared to treating with a DPP4 inhibitor.
This applies to patients with Type 2 diabetes who had no prior heart disease.
This reduced risk implies about three fewer instances of heart failure, death, heart attack, or stroke per 1,000 people using the medication for a year.
On the other hand, SGLT2 inhibitors did not lessen MACE and heart failure hospitalization compared to DPP4 inhibitors for primary heart disease prevention.
The study included approximately 100,000 veterans who received an initial prescription for an antidiabetic medication (metformin, insulin, or sulfonylurea) from 2001 to 2016, and then added a GLP1 receptor agonist, SGLT2 inhibitor, or DPP4 inhibitor to their diabetes treatment regimen.
Conclusions and Implications
Given that diabetes and its complications pose a massive healthcare burden, causing almost 200,000 deaths annually, mainly due to heart disease, these findings are crucial.
Senior author of the study, Christianne Roumie, MD, MPH, emphasized the need for future primary prevention trials with these antidiabetic medications.
The results suggest that GLP1 receptor agonists may offer an advantage over DPP4 inhibitors for patients with type 2 diabetes without previous heart disease.
However, more research, especially in more diverse patient populations, is necessary to determine the best treatment for patients at risk for heart disease due to type 2 diabetes.
Clinicians should consider adding a GLP1 receptor agonist to older patients with type 2 diabetes’ treatment regimen as it may provide heart health protection.
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The study is available in the Annals of Internal Medicine for those interested in further details.
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