Liraglutide better at preventing heart outcomes vs. three other glucose-lowering therapies
PHILADELPHIA — In the cardiovascular outcomes analysis of the GRADE trial, liraglutide was linked to lower risk for certain CV outcomes compared with other glucose-lowering therapies, researchers reported. Jennifer B. Green, MD, professor of medicine at Duke University School of Medicine and member in the Duke Clinical Research Institute, presented the results, which were previously published in Circulation, at the Heart in Diabetes CME Conference.
GRADE compared the GLP-1 receptor agonist liraglutide (Victoza, Novo Nordisk), the DPP-IV inhibitor sitagliptin (Januvia, Merck), the third-generation sulfonylurea glimepiride and insulin glargine (Lantus, Sanofi) in adults with type 2 diabetes. As Healio previously reported, in the main results, all four were safe and lowered HbA1c, but primary metabolic outcome of an HbA1c of less than 7% occurred more often in those randomly assigned liraglutide or insulin glargine than in those assigned glimepiride or sitagliptin.
The CV outcomes analysis included 4,730 patients from GRADE (mean age, 57 years; 36% women; 66% white) who completed a mean of 5 years of follow-up. Most patients were on BP and/or lipid-lowering medications, but only 6.5% had a history of heart attack or cerebrovascular accident at baseline.
The outcomes of interest were MACE-3, defined as CV death, MI and stroke; MACE-4, defined as MACE-3 plus unstable angina requiring hospitalization or revascularization; MACE-5, defined as MACE-4 plus revascularization; MACE-6, defined as MACE-5 plus HF hospitalization; and the individual components.
When the researchers calculated rate ratios comparing each of the other therapies with liraglutide for MACE-6, all three were elevated, though the insulin glargine comparison was no longer significant after adjustment for multiple comparisons, Green said.
Consider lifetime CV risk
“The GRADE outcomes suggest that using liraglutide may also reduce the risk of CV events, even in a relatively low-risk group of patients with type 2 diabetes compared to treatment with the other commonly used glucose-lowering medications which were studied in the trial,” Green said during the presentation. “We would posit that given the substantial lifetime CV risk associated with type 2 diabetes, the current dichotomy in the care of high vs. lower cardiovascular risk in patients with type 2 diabetes may not be justifiable.”
June 21, 2024
