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Clinical Utility of Cardiovascular Risk Scores for Identification of People With Type 2 Diabetes More Likely to Benefit From Either GLP-1 Receptor Agonist or SGLT2 Inhibitor Therapy
Diabetes Care ( IF 16.2 ) Pub Date : 2022-07-01 , DOI: 10.2337/dc21-1929
Julian W. Sacre, Dianna J. Magliano, Jonathan E. Shaw

OBJECTIVE Differentiation of risk for major adverse cardiovascular events (MACE) from heart failure hospitalization (HHF) or kidney disease is important when selecting glucose-lowering therapy. We investigated the ability of separate MACE and HHF risk scores to 1) differentiate MACE from HHF risk; and 2) identify individuals more likely to benefit from either glucagon-like peptide-1 receptor agonists (GLP-1RAs) or sodium–glucose cotransporter-2 inhibitors (SGLT2is). RESEARCH DESIGN AND METHODS We identified three trials in type 2 diabetes that reported cardiovascular outcomes stratified by Thrombolysis In Myocardial Infarction Risk Scores for MACE and HHF. Pooled placebo-arm rates of HHF, MACE, and their ratio and estimated GLP-1RA– and SGLT2i-mediated reductions in events (MACE and HHF combined) were compared across cardiovascular risk strata in the trial populations. RESULTS The HHF rate was less frequent than MACE at all risk levels but increased from 18% of the MACE rate at low-intermediate HHF risk to 61% at highest HHF risk. Similarly, with increasing MACE risk, the incidence of HHF increased from 19% of the MACE incidence in those at low MACE risk to 51% in those with the highest MACE risk. Estimated GLP-1RA– and SGLT2i-mediated reductions in cardiovascular events were similar in those at low-intermediate MACE or HHF risk but tended to favor SGLT2is at higher risk levels of both scores. CONCLUSIONS A greater increase in the rate of HHF relative to MACE was observed with progressively higher cardiovascular risk, regardless of the risk score applied. Consequently, SGLT2is may offer greater overall cardiovascular protection in those at highest MACE risk, not just those at highest HHF risk.

中文翻译:

心血管风险评分在识别更可能受益于 GLP-1 受体激动剂或 SGLT2 抑制剂治疗的 2 型糖尿病患者中的临床应用

目的 在选择降糖治疗时,区分主要不良心血管事件 (MACE) 与心力衰竭住院 (HHF) 或肾脏疾病的风险很重要。我们调查了单独的 MACE 和 HHF 风险评分以 1)区分 MACE 和 HHF 风险的能力;2) 确定更可能受益于胰高血糖素样肽 1 受体激动剂 (GLP-1RAs) 或钠-葡萄糖协同转运蛋白 2 抑制剂 (SGLT2is) 的个体。研究设 HHF、MACE、在试验人群的心血管风险层中比较了它们的比率和估计的 GLP-1RA 和 SGLT2i 介导的事件减少(MACE 和 HHF 联合)。结果在所有风险水平上,HHF 发生率均低于 MACE,但从低中度 HHF 风险的 MACE 发生率的 18% 增加到最高 HHF 风险的 61%。同样,随着 MACE 风险的增加,HHF 的发生率从低 MACE 风险人群的 MACE 发生率的 19% 增加到 MACE 风险最高的人群的 51%。估计 GLP-1RA 和 SGLT2i 介导的心血管事件减少在中低 MACE 或 HHF 风险的患者中相似,但倾向于在两个评分的较高风险水平下倾向于 SGLT2is。结论 观察到 HHF 发生率相对于 MACE 的增加更大,心血管风险逐渐升高,无论应用的风险评分如何。因此,SGLT2is 可能为 MACE 风险最高的人提供更好的整体心血管保护,而不仅仅是 HHF 风险最高的人。
更新日期:2022-07-01
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