Abstract 4373350: Efficacy of GLP-1 Receptor Agonists VS SGLT2 Inhibitors on Cardiovascular Outcomes in Women with Type 2 Diabetes and Premature Coronary Artery Disease: A Propensity Score Matched Analysis

Abstract

Background: Premature Coronary artery disease (CAD) in women is typically defined as coronary artery disease before age 55. This condition is becoming increasingly recognized, however it is understudied. Glucagon-like peptide 1 receptor agonist (GLP-1 RA) and Sodium Glucose Linked Transporter 2 (SGLT2) inhibitors have emerged as cornerstone for management of Type 2 Diabetes mellitus with roles expanding beyond glycemic control. However, the comparative effectiveness in women with premature CAD is unclear. This study set out to compare the efficacy of GLP-1 receptor agonist against SGLT2 inhibitors on cardiovascular outcomes in females with Type 2 Diabetes mellitus (T2DM) and premature CAD. Methods: This retrospective cohort study utilized data from the TrinetX database encompassing adult female patients aged less than 55 years diagnosed with T2DM and CAD between January 2003 and January 2022. Cohort 1 consisted of patients with T2DM, CAD treated with GLP-1RA for at least 1 year and cohort 2 included patients with type T2DM and CAD treated with SGLT2. Propensity score matching (PSM) analysis compared cohort 1 and cohort 2 patients. After PSM, the study included 815 patients in each cohort, predominantly white females. There were similar demographic and clinical characteristics between the cohorts Results: The analysis showed that there was no difference in reduction in 3-point major adverse cardiovascular events (MACE) (HR: 0.627 ,95% CI 0.523-0.753, p=0.243), need for PCI/CABG (HR:0.496, 95% CI:0.267-0.921, p=0.975) and recurrent Myocardial Infarction ( HR:0.601,95% CI :0.487-0.741,P=0.449) among both cohorts. Furthermore, there was also no difference in reduction of risk of Atrial fibrillation (HR :0.480, 95%CI :0.263-0.878 , P=0.510) and new ESRD requiring dialysis (HR:0.781,95% CI: 0.397-1.537, p=0.121) among both cohorts, however GLP-1 cohort was associated with decreased risk of hospitalization (HR : 0.653,95% CI: 0.544-0.785, P<0.005). Conclusions: This study suggests that GLP-1RA therapy and SGLT2 inhibitor show similar efficacy regarding cardiovascular outcomes among females with T2DM and premature CAD and there was no significant difference among both groups. These findings also support the pre-existing knowledge regarding cardiovascular benefits conferred by GLP-1 agonists and SGLT2 inhibitors. Further randomized controlled trials are needed to validate these findings especially among the group of patients with premature CAD.