Estimation of the cardiovascular (CV) risk using CVD risk scores can help clinicians to choose between glucagon-like peptide-1 receptor agonists (GLP-1 RA) or sodium/glucose cotransporter-2 inhibitors (SGLT2I) in patients with type 2 diabetes, suggests a study presented at the European Association for the Study of Diabetes (EASD) Annual Meeting held last month in Stockholm, Sweden.¹

A pooled data analysis of the incidence rates of MACE and HHF obtained from the DECLARE-TIMI, EMPA-REG OUTCOME and SAVOR-TIMI CVD outcomes trials was carried out in this study. The incidence rates of MACE were stratified by the Thrombolysis In Myocardial Infarction (TIMI) Risk Score for MACE (TRS-2°P; range: 1-10 points), while the incidence rates of HHF were stratified by the TIMI Risk Score for HHF (TRS-HF_DM; range: 0-7 points).

A pooled analysis of the event rates in the placebo group was compared with the MACE and HHF risk groups. The published relative risk reductions with GLP-1 RAs (HR=0.86 for MACE; 0.89 for HHF) and SGLT2Is (HR=0.90 for MACE; 0.68 for HHF) were applied to the pooled event rates to determine the overall reduction in the CV events in the two risk groups.¹

The HHF rates increased considerably more than the rates of MACE as the cardiovascular risk increased according to both risk scores. The incidence rates of HHF increased to 61% of incidence of MACE among patients at the highest HHF risk, and to 51% of incidence of MACE among those at highest MACE risk. However, among patients at low to intermediate HHF risk, the HHF rates were 18% of incidence rates of MACE and 19% at low MACE risk.¹

Both atherosclerotic cardiovascular disease (ASCVD) and heart failure are a significant cause of morbidity and mortality among patients with type 2 diabetes. The effect of the antidiabetic drugs on CV risk influences the choice of therapy for patients with type 2 diabetes at high risk for cardiovascular events. This study has shown that HHF occurs only occasionally in patients at low to intermediate CV risk. But, in patients with “progressively higher CVD risk”, the increase in HHF is much more than that of MACE. The researchers noted that the “estimated GLP-1RA- and SGLT2I-mediated reductions in CVD events were similar at low-intermediate MACE or HHF risk, but tended to favour SGLT2is at higher risk levels of both scores” meaning that all patients at greatest risk of CV risk benefit from the cardioprotective effects of SGLT2Is and not just those at high risk of HHF alone. Addition of SGLT2is to the standard treatment therefore may lead to greater reduction in the risk of CV events in patients with diabetes.

Reference

1. Sacre JW, et al. Abstract 811. Using CVD risk scores to select between GLP-1RA or SGLT2i therapy in type 2 diabetes: modelling the combined effects on both major atherosclerotic and heart failure events. 58th EASD 2022. Diabetologia. 2022;65 (Suppl 1): S418-S419.