What is the clinical evidence from this study?

Study design: Observational. Population: Type 2 diabetes mellitus after acute myocardial infarction (n=663). Intervention: GLP-1 RAs and SGLT2i combination therapy vs. No combination therapy. Primary outcome: Major adverse cardiac events (MACE) (p=0.0004).

What does this research mean for the field?

SGLT-2i/GLP-1RAs combination therapy reduced the incidence of major adverse cardiac events by 3.2% compared to standard care in T2D patients after acute myocardial infarction. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

What question did this study set out to answer?

This study aims to evaluate the impact of GLP-1 receptor agonists and SGLT-2 inhibitors on major cardiac events after an acute myocardial infarction in type 2 diabetes patients.

February 6, 2026

Glucagon-like peptide-1 receptor agonists and sodium glucose cotransporter-2 inhibitors combination therapy after acute myocardial infarction in patients with type 2 diabetes mellitus: a dynamic duo

Key Result

Combination therapy with GLP-1 RAs and SGLT2i was associated with a lower incidence of MACE (20.5% vs. 23.7%, p=0.0004) in patients with type 2 diabetes after acute myocardial infarction.

Key Points

This study aims to evaluate the impact of GLP-1 receptor agonists and SGLT-2 inhibitors on major cardiac events after an acute myocardial infarction in type 2 diabetes patients.
Conducted a prospective observational study in a tertiary care hospital.
Included type 2 diabetes patients hospitalized for acute coronary syndrome and followed for 12 months.
Collected data on demographics, comorbidities, medications, and instances of major adverse cardiac events.
Out of 2757 ACS patients, 663 were type 2 diabetes patients, with 157 receiving the combination therapy.
Patients using the combination achieved a median BMI decrease, indicating significant weight loss.
The incidence of major adverse cardiac events was lower in the combination therapy group (20.5% vs. 23.7%).

Study Design

Type

Observational (n=663)

Multicenter

Structured PICO

Does combination therapy with GLP-1 RAs and SGLT2i reduce MACE in patients with type 2 diabetes after acute myocardial infarction?

Population

663 patients with type 2 diabetes mellitus hospitalized for acute coronary syndrome, median age 67 years, 68.5% male.

Intervention

Combination therapy with GLP-1 receptor agonists (semaglutide) and SGLT-2 inhibitors prescribed at discharge or during follow-up.

Comparator

Patients not receiving the combination of GLP-1 RAs and SGLT2i.

Outcome

Major adverse cardiac events (MACE), including cardiovascular death, recurrent acute myocardial infarction, stroke, target vessel revascularization, new-onset heart failure, and atrial fibrillation at 12 months.composite

In patients with type 2 diabetes after acute myocardial infarction, combination therapy with SGLT2 inhibitors and GLP-1 receptor agonists is associated with a lower incidence of MACE and new-onset atrial fibrillation.

Main Result

Absolute Event Rate: 20.5% vs 23.7%

p-value: p=0.0004

Abstract

Abstract Introduction Previous studies have shown that Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and Sodium Glucose Cotransporter-2 Inhibitors (SGLT2i) improved survival in patient with type 2 diabetes mellitus (TD2) after acute myocardial infarction (AMI). GLP-1RAs and SGLT-2i act with different mechanisms, GLP-1RA have been shown to reduce atherosclerosis-related events, while SGLT-2i were demonstrated to reduce the risk of heart failure after AMI. Aim To evaluate the effect of GLP‑1RAs and SGLT-2i combination therapy on major adverse cardiac events (MACE) after AMI Methods This prospective observational study was conducted in tertiary hospital centre and included T2D patients hospitalized for ACS, followed for 12 months. Data on demographics, comorbidities, medications, and MACE, including cardiovascular death, recurrent AIM, stroke, target vessel revascularization, new-onset heart failure and atrial fibrillation (AF) were collected. Statistical analyses were performed using MedCalc software. Results Of 2757 ACS patients, 663 T2D patients were included (68.5% male, 31.5% female), with a median age of 67 years (IQR 59-75). Participant characteristics are summarized in Table 1. A total of 157 patients (23.7%) were prescribed the combination of GLP-1 RAs and SGLT2i combination either at discharge or during follow-up. All the patients in our study used semaglutide as their GLP-1 RAs agent. The SGLT2i/GLP-1RAs group had a higher baseline BMI (32.3 kg/m² vs. 28.6 kg/m², p0.0001) and maintained a higher BMI throughout follow-up (30.2 kg/m² vs. 28.5 kg/m², p0.0001). However, SGLT2i/GLP-1RAs group achieved higher weight loss (median BMI decrease of 1.75 vs. 0.075, p0.0001) and had lower incidence of MACE (20.5% vs. 23.7%, p=0.0004) and AF (24.2% vs 24.4%, p=0.012). Number needed to treat for prevention of MACE was 6. Conclusion In this prospective observational study, SGLT-2i/GLP-1RAs combination therapy was associated with a lower incidence of MACE. What we consider a novel finding is that this combination reduced the incidence of new-onset AF after myocardial infarction probably due to better weight reduction as well as GLP-1RAs positive effect on reducing atrial fibrosis.Baseline characteristics of participants

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