OBJECTIVES: This study examined cardiovascular benefits among patients with T2D newly initiated on SGLT-2i or GLP-1RA using real-world claims data.

METHODS: Patients with T2D over the age of 18 who newly initiated a SGLT-2i or GLP-1RA (the index date) were identified during 2017-2018 using the IBM® MarketScan® Commercial Claims Database. Study endpoint included time to the occurrence of cardiovascular events (congestive heart failure, stroke, ischemic heart disease, or peripheral artery disease) during a two-year follow-up period. Follow-up continued until the outcome occurred, end of the study period (December 31, 2020), discontinuation of study medication, switch to the other study drug class, or discontinuation of enrollment. Cox proportional hazards models compared the rates of cardiovascular events. Models were adjusted for patient characteristics measured during a one-year period pre-index date.

RESULTS: We studied 33,189 adults who initiated SGLT-2i and 52,246 adults who initiated GLP-1RA. The study population was primarily male (53%) with a mean age of 54.2 and 53.2 years in the SGLT-2i and GLP-1RA cohorts respectively. At baseline, 16.1% of all patients had a cardiovascular disease. The crude incidence rate of cardiovascular events was 2.35 and 2.70 per 100 person-years for SGLT-2i and GLP-1RA group, respectively. Patients initiating SGLT-2i had a lower rate of cardiovascular events (HR: 0.78, 95% CI: 0.71-0.85) compared to patients on GLP-1RA. Similar rate reduction was seen with SGLT-2i in patients both with (HR: 0.77, 95% CI: 0.69-0.87) and without prior cardiovascular disease history (HR: 0.78, CI 95%: 0.68 – 0.89).

CONCLUSIONS: Real-world data suggest greater cardioprotective benefit for SGLT2i versus GLP-1RA users. These findings may be useful for clinical decision-making but should also be weighed against the potential risk of adverse events associated with SGLT-2i.