Key result
SGLT-2 inhibitors and GLP-1 receptor agonists provided comparable cardio-kidney benefits in patients with type 2 diabetes, regardless of baseline statin use status.
Why the study?
It was unclear whether the cardiovascular benefits of SGLT-2 inhibitors and GLP-1 receptor agonists differ by baseline use of statins or lipid-lowering therapy in patients with type 2 diabetes.
Do SGLT-2is and GLP-1RAs reduce cardiovascular and kidney events in patients with type 2 diabetes regardless of baseline statin use?
Meta-Analysis
Do SGLT-2is and GLP-1RAs reduce cardiovascular and kidney events in patients with type 2 diabetes regardless of baseline statin use?
SGLT-2 inhibitors and GLP-1 receptor agonists provide comparable cardiovascular and kidney benefits in patients with type 2 diabetes, regardless of baseline statin use.
Supports SGLT-2i or GLP-1RA use in type 2 diabetes irrespective of statin status; confirms no effect modification across CVOT meta-analysis.
BACKGROUND: Whether the cardiovascular treatment benefits of sodium-glucose co-transporter 2 inhibitors (SGLT-2is) and glucagon-like peptide 1 receptor agonists (GLP-1RAs) differ by baseline use of statins/lipid lowering therapy is unclear. This systematic review and meta-analysis investigated whether baseline statin use (users vs non-users) influences the cardiovascular and kidney benefits of SGLT-2is and GLP-1RAs in patients with type 2 diabetes (T2D). METHODS: We identified relevant cardiovascular outcome trials (CVOTs) and observational cohort studies from MEDLINE, Embase, the Cochrane Library, and bibliographic searches up to March 2024. The analysis pooled study-specific hazard ratios (HRs) with 95 % confidence intervals (CIs) for outcomes, categorized by baseline statin use status. We also assessed the interactions between these medications and baseline statin use by calculating and pooling the ratio of HRs (RHRs) within each trial. RESULTS: Twenty-five articles (13 articles comprising 6 unique CVOTs and 12 articles comprising 9 unique cohort studies) were eligible. In CVOTs of SGLT-2is, the HRs (95 % CIs) of MACE; composite of CVD death or hospitalisation for heart failure; stroke; and kidney events in statin users were 0.90 (0.82-1.00), 0.78 (0.60-1.02), 1.00 (0.77-1.31), and 0.60 (0.53-0.69), respectively. The corresponding estimates were similar in non-statin users. In CVOTs of GLP-1RAs, the HRs (95 % CIs) for MACE in statin and non-statin users were 0.81 (0.73-0.90) and 0.92 (0.77-1.11), respectively. In observational cohort studies, SGLT-2is similarly reduced the risk of several cardiovascular and kidney outcomes in both statin and non-statin users. The estimated RHRs and p-values for interaction indicated that baseline statin use status did not significantly modify the cardio-kidney benefits of SGLT-2is and GLP-1RAs. CONCLUSIONS: Aggregate analyses of intervention and real-world evidence show that SGLT-2is and GLP-1RAs provide comparable cardio-kidney benefits in patients with T2D, regardless of baseline statin use status. PROSPERO Registration: CRD42024498939.
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Kunutsor et al. (2024) conducted a meta-analysis in Type 2 diabetes. SGLT-2 inhibitors and GLP-1 receptor agonists vs. Placebo or standard care (stratified by baseline statin use) was evaluated on Major adverse cardiovascular events (MACE) for SGLT-2 inhibitors in statin users (HR 0.90, 95% CI 0.82-1.00). SGLT-2 inhibitors and GLP-1 receptor agonists provided comparable cardio-kidney benefits in patients with type 2 diabetes, regardless of baseline statin use status.
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