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January 4, 2025Cardiovascular Diabetology8 citationsOpen Access

Long-term prognostic impact of glucagon-like peptide-1 receptor agonist before ST-segment elevation myocardial infarction in patients with type 2 diabetes: a nationwide cohort study

JMJasmine Melissa MadsenJLJacob Thomsen LønborgLKLars Køber

Key Result

GLP-1RA treatment prior to STEMI admission was associated with a 40% lower long-term all-cause mortality (adjusted HR 0.60) compared to no GLP-1RA treatment in patients with type 2 diabetes.

Study Design

Type

Cohort (n=1,421)

Multicenter

Yes

Structured PICO

Does GLP-1RA treatment before STEMI reduce long-term mortality in patients with type 2 diabetes and STEMI?

P
Population
1,421 adults with type 2 diabetes and STEMI treated with PCI, followed for a median of 8.4 years to assess the prognostic impact of prior GLP-1RA treatment.
E
Exposure
Glucagon-like peptide-1 receptor agonist (GLP-1RA) dispensed within one year before STEMI
C
Comparator
No GLP-1RA treatment within one year before STEMI
O
Outcome
Long-term mortality over 8.4 yearshard clinical

Prior treatment with GLP-1RAs is associated with significantly lower long-term mortality in patients with type 2 diabetes who experience a STEMI.

Main Result

Hazard Ratio: 0.6 (95% CI 0.43–0.84)

Absolute Event Rate: 36% vs 52%

p-value: p=0.003

Limitations

  • Observational design cannot prove causality
  • Potential exclusion of undiagnosed diabetes or misclassification
  • Lack of data on eGFR, HbA1c, and LVEF leading to potential residual confounding
  • Differences in baseline anti-diabetic treatments between groups
  • Lack of cause-specific mortality data

Abstract

BACKGROUND: Glucagon-like peptide-1 receptor agonist (GLP-1RA) treatment reduces cardiovascular events in type 2 diabetes. Yet, the impact of GLP-1RA treatment before ST-segment elevation myocardial infarction (STEMI) on long-term prognosis in patients with type 2 diabetes remains unclear. In patients with STEMI and type 2 diabetes, we aimed to investigate the association between long-term prognosis and GLP-1RA treatment before STEMI. METHODS: This nationwide cohort study included consecutive patients admitted with type 2 diabetes and STEMI in Denmark from 2010 to 2016. All data were retrieved from nationwide Danish registries. Type 2 diabetes was defined by prior hospital admission with type 2 diabetes or anti-diabetic prescriptions within one year before STEMI. Dispensed GLP-1RA medication was retrieved within one year before STEMI. RESULTS: Of 1421 patients with STEMI and diabetes, 7% were treated with GLP-1RA before STEMI and 93% were not. Patients treated with GLP-1RA were younger, had more comorbidities, and more often treated with other anti-diabetics. During 8.4 years, 36% patients treated with GLP-1RA died whereas 52% died in the no GLP-1RA group (p = 0.002). In adjusted Cox analysis, GLP-1RA was associated with lower long-term mortality (hazard ratio (HR) 0.60, 95% confidence interval (CI) 0.43-0.84). There was no association between GLP-1RA and ischemic stroke (adjusted HR 1.05, 95% CI 0.57-1.94), recurrent myocardial infarction (adjusted HR 0.74, 95% CI 0.48-1.15), or hospitalisation for heart failure (adjusted HR 0.71, 95% CI 0.48-1.05). CONCLUSIONS: In patients with diabetes and STEMI, GLP-1RA treatment prior to STEMI admission was associated with significantly lower long-term mortality.

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Cite This Study

Madsen et al. (2025) conducted a cohort in Type 2 diabetes and ST-segment elevation myocardial infarction (STEMI) (n=1,421). Glucagon-like peptide-1 receptor agonist (GLP-1RA) vs. No GLP-1RA treatment was evaluated on All-cause mortality (HR 0.60, 95% CI 0.43-0.84, p=0.003). GLP-1RA treatment prior to STEMI admission was associated with a 40% lower long-term all-cause mortality (adjusted HR 0.60) compared to no GLP-1RA treatment in patients with type 2 diabetes.

synapsesocial.com/papers/6a95704e27d587408825f71chttps://doi.org/10.1186/s12933-024-02548-w
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Also Consider

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