Comparative Cardiovascular Effectiveness of Glucagon-Like Peptide 1 Receptor Agonists and Sodium-Glucose Cotransporter 2 Inhibitors in Diabetes Mellitus

作者：Fan Bu, ruopeng wu, Anna Ostropolets, Arya Aminorroaya, Hsin Yi Chen, Yi Chai, Lovedeep Singh Dhingra, Thomas Falconer, Jason C. Hsu, Chungsoo Kim, Wallis C. Y. Lau, Kenneth K. C. Man, Evan Minty, Daniel R. Morales, Akihiko Nishimura, Phyllis Thangraraj, Mui Van Zandt, Can Yin, Rohan Khera, George Hripcsak, Marc A. Suchard · 发表于：Journal of the American College of Cardiology · 年份：2026 · DOI：10.1016/j.jacc.2026.02.5123 · 被引用次数：1 · 研究领域：Diabetes Treatment and Management、Bariatric Surgery and Outcomes、Heart Failure Treatment and Management

BACKGROUND: Glucagon-like peptide 1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter 2 inhibitors (SGLT2Is) have established cardiovascular benefits for patients with type 2 diabetes mellitus (T2DM), with similar class-level effectiveness found in previous studies. However, real-world comparative effectiveness assessments of individual agents remain limited. OBJECTIVES: The goal of this study was to compare the cardiovascular effectiveness of individual GLP-1RAs and SGLT2Is. METHODS: We conducted a multinational, retrospective, new-user active-comparator cohort study using 10 U.S. and non-U.S. administrative claims and electronic health record databases. The study included 1,245,211 adults with T2DM receiving metformin who initiated second-line therapy with 1 of 6 GLP-1RAs (albiglutide, dulaglutide, exenatide, liraglutide, lixisenatide, semaglutide) or 1 of 4 SGLT2Is (canagliflozin, dapagliflozin, empagliflozin, ertugliflozin). Empagliflozin (393,499; 31.6%), semaglutide (235,585; 18.9%), dapagliflozin (208,666; 16.8%), and dulaglutide (207,348; 16.8%) were most commonly used. A secondary subgroup analysis included 316,242 patients with established cardiovascular diseases (CVDs). Primary outcomes were 3-point major adverse cardiovascular events (MACEs) (acute myocardial infarction, stroke, sudden cardiac death) and 4-point MACE (adding hospitalization/emergency room visit with heart failure). Secondary outcomes included the individual components. HRs were estimat...