Diabetes, obesity & metabolism 2017 04 13() doi 10.1111/dom.12969
To assess the potential impact of GLP-1 RA exposure on cardiovascular disease (CVD) and mortality outcomes in patients with type 2 diabetes (T2D), using a large retrospective cohort.
MATERIALS AND METHODS
Patients with T2D between 2005-2014 (N = 105,862) were identified in the electronic health record system at Cleveland Clinic using a validated electronic phenotype. A time-dependent, Cox, multiple regression analysis was used to assess the association between GLP-1 RA exposure and risk of acute myocardial infarction (AMI), stroke/cerebrovascular accident (CVA), and overall mortality, as well as the composite of all three outcomes. The findings were further evaluated by assessing the effect of GLP-1 RA on the same variables in patients with and without prior CVD. The model adjusted for differences in demographic information, hypertension, lab/vitals, past history of outcomes, and T2D medications.
There were significantly lower rates of AMI (hazard ratio [HR] = 0.80, 95% CI=0.65-0.99, P = 0.045), CVA (HR=0.82, 95% CI=0.74-0.91, P < 0.001), overall mortality (HR=0.48, 95% CI=0.41-0.57, P < 0.001), and the composite outcome (HR=0.82, 95% CI=0.74-0.91, P < 0.002) during the consolidated time that patients were exposed to GLP-1 RA compared to corresponding rates during intervals without GLP-1 RA exposure. GLP-1 RA was associated with a significant decrease in CVA, mortality, and the composite outcome in patients with and without established CVD, not significantly affecting AMI in these subgroups. CONCLUSIONS
GLP-1 RA exposure was found to be associated with a reduction in the risk of cardiovascular events observed and overall mortality among patients with T2D with and without established CVD, after adjusting for potential confounders.