1671-P: Heterogeneity of Treatment Effect of Glucagon-Like Peptide 1 Receptor Agonists for Secondary Prevention of Cardiovascular Events in Type 2 Diabetes

Introduction and Objective: GLP-1RA have emerged as a mainstay T2DM treatment and are known to reduce cardiovascular risk; however, whether these benefits vary across patient subgroups remains unclear. Methods: We conducted a retrospective cohort study using a new-user, active-comparator target trial emulation approach. The primary exposure was prescription of a GLP-1RA, with prescription of a SGLT2i or DPP-IVi as the comparator. The primary end point was time to first major adverse cardiovascular/cerebrovascular event (MACCE). Propensity score overlap weighting combined with LASSO was used to balance patient characteristics— including medical history, laboratory/physical measures, and social determinants of health— and estimate causal subgroup effects. Results: In total, 179,081 patients with T2DM with a history of cardiovascular disease (CVD) were prescribed a GLP-1RA and 405,952 were prescribed an SGLT2i or DPP-IVi. Estimated treatment effects are shown in Figure 1. In summary, GLP-1RA prescription was associated with lower risk of MACCE for all subgroups except Asian patients. Greater risk reductions were observed among women, older adults, and patients with low to moderate baseline CVD recurrence risk. Conclusion: Among patients with T2DM with a history of CVD, GLP-1RA prescription was associated with a lower risk of MACCE across most subgroups compared with SGLT2i or DPP-IVi. Disclosure J.B. Lusk: None. J. Shin: None. L. Wilson: Research Support; Ended; Pfizer Inc., Bristol-Myers Squibb Company. C. Powell: None. P. Madala: None. E. OBrien: Research Support; Current; Pfizer Inc. F. Li: None. B. Mac Grory: None. Funding American Heart Association Data Science (25GLP1450119), National Institutes of Health (P30AG072958)