Marco Trevisan1, Edouard L Fu2, Karolina Szummer3,4, Anna Norhammar5,6, Pia Lundman7, Christoph Wanner8, Arvid Sjölander1, Tomas Jernberg7, Juan Jesus Carrero1. 1. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, 171 77 Stockholm, Sweden. 2. Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands. 3. Department of Cardiology, Karolinska University Hospital, Solna, Sweden. 4. Department of Medicine, Karolinska Institutet, Huddinge, Sweden. 5. Department of Medicine, Karolinska Institutet, Solna, Sweden. 6. Capio Saint Görans hospital, Stockholm, Sweden. 7. Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden. 8. Department of Medicine, Würzburg University Clinic, Würzburg, Germany.
Abstract
AIMS: Trial evidence indicates that glucagon-like peptide-1 receptor agonists (GLP-1 RAs) may reduce the risk of cardiovascular (CV) events in patients with diabetes and myocardial infarction (MI). We aimed to expand this observation to routine care settings. METHODS AND RESULTS: Prospective observational study including all patients with diabetes surviving an MI and registered in the nationwide SWEDEHEART registry during 2010-17. Multivariable Cox regression analyses were used to estimate the association between GLP-1 RAs use and the study outcome, which was a composite of stroke, heart failure, Re-infarction, or CV death. Covariates included demographics, comorbidities, presentation at admission, and use of secondary CV prevention therapies. In total, 17 868 patients with diabetes were discharged alive after a first event of MI. Their median age was 71 years, 36% were women and their median estimated glomerular filtration rate was 75 mL/min/1.73m2. Of those, 365 (2%) were using GLP-1 RAs. During median 3 years of follow-up, 7005 patients experienced the primary composite outcome. Compared with standard of diabetes care, use of GLP-1 RAs was associated with a lower event risk [adjusted hazard ratio (HR) 0.72; 95% confidence interval (CI): 0.56-0.92], mainly attributed to a lower rate of re-infarction and stroke. Results were similar after propensity score matching or when compared with users of sulfonylurea. There was no suggestion of heterogeneity across subgroups of age, sex, chronic kidney disease, and STEMI. CONCLUSION: GLP-1 RAs use, compared with standard of diabetes care, was associated with lower risk for major CV events in healthcare-managed survivors of an MI.
AIMS: Trial evidence indicates that glucagon-like peptide-1 receptor agonists (GLP-1 RAs) may reduce the risk of cardiovascular (CV) events in patients with diabetes and myocardial infarction (MI). We aimed to expand this observation to routine care settings. METHODS AND RESULTS: Prospective observational study including all patients with diabetes surviving an MI and registered in the nationwide SWEDEHEART registry during 2010-17. Multivariable Cox regression analyses were used to estimate the association between GLP-1 RAs use and the study outcome, which was a composite of stroke, heart failure, Re-infarction, or CV death. Covariates included demographics, comorbidities, presentation at admission, and use of secondary CV prevention therapies. In total, 17 868 patients with diabetes were discharged alive after a first event of MI. Their median age was 71 years, 36% were women and their median estimated glomerular filtration rate was 75 mL/min/1.73m2. Of those, 365 (2%) were using GLP-1 RAs. During median 3 years of follow-up, 7005 patients experienced the primary composite outcome. Compared with standard of diabetes care, use of GLP-1 RAs was associated with a lower event risk [adjusted hazard ratio (HR) 0.72; 95% confidence interval (CI): 0.56-0.92], mainly attributed to a lower rate of re-infarction and stroke. Results were similar after propensity score matching or when compared with users of sulfonylurea. There was no suggestion of heterogeneity across subgroups of age, sex, chronic kidney disease, and STEMI. CONCLUSION: GLP-1 RAs use, compared with standard of diabetes care, was associated with lower risk for major CV events in healthcare-managed survivors of an MI.
Authors: Hertzel C Gerstein; Helen M Colhoun; Gilles R Dagenais; Rafael Diaz; Mark Lakshmanan; Prem Pais; Jeffrey Probstfield; Jeffrey S Riesmeyer; Matthew C Riddle; Lars Rydén; Denis Xavier; Charles Messan Atisso; Leanne Dyal; Stephanie Hall; Purnima Rao-Melacini; Gloria Wong; Alvaro Avezum; Jan Basile; Namsik Chung; Ignacio Conget; William C Cushman; Edward Franek; Nicolae Hancu; Markolf Hanefeld; Shaun Holt; Petr Jansky; Matyas Keltai; Fernando Lanas; Lawrence A Leiter; Patricio Lopez-Jaramillo; Ernesto German Cardona Munoz; Valdis Pirags; Nana Pogosova; Peter J Raubenheimer; Jonathan E Shaw; Wayne H-H Sheu; Theodora Temelkova-Kurktschiev Journal: Lancet Date: 2019-06-09 Impact factor: 79.321
Authors: S L Woodfield; C F Lundergan; J S Reiner; S W Greenhouse; M A Thompson; S C Rohrbeck; Y Deychak; M L Simoons; R M Califf; E J Topol; A M Ross Journal: J Am Coll Cardiol Date: 1996-12 Impact factor: 24.094
Authors: Henrik Svanström; Peter Ueda; Mads Melbye; Björn Eliasson; Ann-Marie Svensson; Stefan Franzén; Soffia Gudbjörnsdottir; Kristian Hveem; Christian Jonasson; Björn Pasternak Journal: Lancet Diabetes Endocrinol Date: 2018-12-05 Impact factor: 32.069
Authors: Shi Yin Wong; Ainsley Ryan Yan Bin Lee; Aaron Hon Jiun Sia; Yu Jun Wo; Yao Hao Teo; Yao Neng Teo; Nicholas L Syn; Ching-Ching Ong; Lynette L Teo; Tiong-Cheng Yeo; Kian-Keong Poh; William K Kong; Raymond C Wong; Ching-Hui Sia Journal: Cardiovasc Drugs Ther Date: 2022-07-12 Impact factor: 3.947
Authors: Filipe Ferrari; Rafael S Scheffel; Vítor M Martins; Raul D Santos; Ricardo Stein Journal: Am J Cardiovasc Drugs Date: 2021-12-27 Impact factor: 3.283