Sodium-Glucose Cotransporter 2 Inhibitors, Glucagon-Like Peptide-1 Receptor Agonists, and Dipeptidyl Peptidase-4 Inhibitors, and Risk of Hospitalization.
Sodium-Glucose Cotransporter 2 Inhibitors, Glucagon-Like Peptide-1 Receptor Agonists, and Dipeptidyl Peptidase-4 Inhibitors, and Risk of Hospitalization.
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DOI：
10.1016/j.amjcard.2021.11.013
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发表时间：
2022-02-15
期刊：
影响因子：
--
通讯作者：
Shin JI
中科院分区：
文献类型：
--
作者：
Lyu B;Grams ME;Chang A;Inker LA;Coresh J;Shin JI
临床试验已经证明，钠-葡萄糖共转运体2抑制剂(SGLT2i)和胰升糖素样肽1受体激动剂(GLP1RA)对心血管有益。然而，在现实世界的实践中，它们对所有原因和特定原因住院的影响尚不清楚。我们在Geisinger Health System中确定了2015至2018年间应用SGLT2i(n=2492)、GLP1RA(n=1982)或二肽基肽酶-4抑制剂(DPP4i，n=2492)的糖尿病患者。我们使用COX比例风险回归分析了全因住院(净受益指标)和心血管疾病住院(心血管受益指标)，以及非心血管疾病住院(伤害指标)。在16个月的中位随访期间，与DP4i相比，SGLT2i和GLP1RA的全因住院风险(SGLT2i的HR[95%CI]0.85[0.75~0.95]；GLP1RA的0.89[0.78，0.98])以及心血管住院的风险(SGLT2i的0.61[0.47~0.79]；GLP1RA的0.77[0.60，0.99])较低。在SGLT2i和GLP1RA中，全因和心血管疾病住院的风险相似。与DPP4i相比，SGLT2i与心肌梗死和心力衰竭(HF)住院的风险显著降低，与GLP1RA相比，SGLT2i与HF住院的风险更低。非心血管疾病住院的风险在不同的治疗组没有差异。这些来自现实世界比较的结果进一步鼓励SGLT2i和GLP1RA在常规糖尿病护理中使用，特别是在心血管事件高危患者中。
Clinical trials have demonstrated cardiovascular benefits of sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP1RA). However, their impact on all-cause and cause-specific hospitalization in real-world practice remains unclear. We identified patients with diabetes who initiated SGLT2i (n=2492), GLP1RA (n=1982), or dipeptidyl peptidase-4 inhibitors (DPP4i, n=2492) between 2015 and 2018 in Geisinger Health System. We examined all-cause hospitalization (net benefit indicator) and cardiovascular disease (CVD) hospitalization (CV benefit indicator), as well as non-CVD hospitalization (harm indicator), using Cox proportional hazards regression. During a median follow-up of 16 months, SGLT2i and GLP1RA were associated with lower risk of all-cause hospitalization (HR [95% CI] 0.85 [0.75–0.95] for SGLT2i; 0.89 [0.78, 0.98] for GLP1RA) as well as CVD hospitalization (0.61 [0.47–0.79] for SGLT2i; 0.77 [0.60, 0.99] for GLP1RA) compared with DPP4i. The risks of all-cause and CVD hospitalization were similar between SGLT2i and GLP1RA. SGLT2i was associated with substantially lower risk of myocardial infarction and heart failure (HF) hospitalization compared with DPP4i and lower risk of HF hospitalization compared with GLP1RA. The risk of non-CVD hospitalization did not differ by the treatment groups. These results from real-world comparison further encourage SGLT2i and GLP1RA use in routine diabetes care, particularly among patients at high risk of cardiovascular events.
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