Diabetes, specifically type 2 diabetes (T2D), poses a significant risk for cardiovascular disease.
Two classes of drugs commonly used to treat T2D are SGLT2 inhibitors (SGLT2i) and GLP-1 receptor agonists (GLP-1RA).
Both have been found to reduce major adverse cardiovascular events, but the extent of their effectiveness may differ between men and women.
Despite women with T2D being at higher cardiovascular risk, treatment strategies for diabetes-related heart issues have not considered gender-specific variations.
The Study
Researchers from the Monash Institute of Pharmaceutical Sciences conducted a population-based cohort study in Australia.
The study included 8,026 men and women with T2D who were discharged from a Victorian hospital between July 1, 2013, and July 1, 2017, and were prescribed either SGLT2i or GLP-1RA within 60 days of discharge.
The aim was to compare the effects of these medications on major adverse cardiovascular events in men and women, with additional analyses based on age and heart failure history.
Findings
SGLT2i treatment resulted in a more significant reduction in major adverse cardiovascular events, such as heart failure and stroke, in men with T2D compared to women of the same age group.
Overall, men treated with SGLT2i experienced a 22% reduction in major cardiovascular events compared to those prescribed GLP-1RA, while there was no significant difference in women’s outcomes between the two drug classes.
For the first time, the study demonstrated that SGLT2i outperformed GLP-1RA in reducing major cardiovascular events in both older men and women (aged 65 and above) with T2D, in men with a history of heart failure, and in women with pre-existing atherosclerotic cardiovascular disease.
Discussion
The study’s lead author, Abhipree Sharma, highlighted the need for further investigation into the differing effects of SGLT2i and GLP-1RA based on age and gender.
Current treatment recommendations for T2D-related cardiovascular disease do not consider these factors, despite known variations in the development and presentation of these conditions.
Professor Rebecca Ritchie, leader of Heart Failure Pharmacology at MIPS, pointed out that women with T2D often present with more risk factors for cardiovascular disease than men with the same condition.
Additionally, postmenopausal women experience an increased risk of heart issues, suggesting a role for estrogen in cardioprotection.
The study’s findings emphasize the importance of tailoring pharmacological treatment recommendations based on sex, age, and heart disease history.
Further research is needed to explore these nuances and improve outcomes for individuals with T2D, particularly women, who may face unique cardiovascular risks and benefits from diabetes medications.
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The research findings can be found in The Lancet Regional Health—Western Pacific.
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