Comparative CVD Efficacy of Newer Glucose-Lowering Drugs in Elderly T2D Patients

A Danish nationwide cohort study provided real world evidence that both glucagon-like peptide 1 receptor agonists (GLP1-RAs) and sodium-glucose cotransporter 2 inhibitors (SGLT-2is) were associated with reduced rates of 3-point major adverse cardiovascular events (3P-MACE) and hospitalization for heart failure (HHF) compared to dipeptidyl peptidase 4 inhibitors (DPP-4is). Compared to GLP1-RAs, SGLT-2is were associated with reduced rates of HHF. The study included 35,679 participants aged ≥70 years who were new users (DPP-4is: 62%, GLP1-RAs: 16%, SGLT-2is: 23%) between 2012 and 2020. In the as-treated analysis, GLP1-RAs and SGLT-2is were associated with significantly reduced rates of 3P-MACE and HHF compared to DPP-4is. The overall incidence rate ratios (IRR) for 3P-MACE was 0.68 (GLP1-RAs vs. DPP4is) and 0.65 (SGLT-2is vs. DPP4is), while for HHF the IRR was 0.81 (GLP1-RAs vs. DPP4is) and 0.60 (SGLT-2is vs. DPP4is). These effects were predominantly independent of age. Compared to GLP1-RAs, SGLT-2is were associated with a significant reduction of HHF, with an overall IRR of 0.75. No significant difference was observed between SGLT-2is and GLP1-RAs on 3P-MACE. The results confirm the cardiovascular benefits of newer glucose-lowering drugs in elderly populations and support current guidelines. Source: https://www.thelancet.com/