Cardiovascular Outcomes With Antidiabetic Drugs in People With Type 2 Diabetes and a Prior Stroke

초록

Objective: To assess the comparative effectiveness of sodium-glucose cotransporter 2 inhibitors (SGLT2i), thiazolidinediones (TZD), and dipeptidyl peptidase-4 inhibitors (DPP-4i) for the cardiorenal outcomes and mortality in individuals with type 2 diabetes and a prior stroke. Patients and Methods: Using the Korean National Health Insurance Service database from 2014 to 2021, a new-user cohort was established through propensity score matching for SGLT2i, TZD, and DPP-4i. The primary outcomes were major adverse cardiovascular events (MACE), comprising myocardial infarction, ischemic stroke, and cardiovascular death. Secondary outcomes included individual components of MACE, hospitalization for heart failure, a composite kidney outcome, and all- cause mortality. Weighted Cox proportional hazard models were used to calculate HRs and 95% CIs. Results: Among 9733 participants (mean age, 67.2 +/- 3.2 years; 46.8% women), the incidence rate of MACE was 220, 202, and 251 per 1000 person-years for the SGLT2i, TZD, and DPP-4i groups. SGLT2i (HR, 0.86; 95% CI, 0.77 to 0.97; P1/4.01) and TZD (HR, 0.80; 95% CI, 0.70 to 0.90; P<.001) showed a lower risk of MACE compared to DPP-4i. Importantly, no significant difference in MACE was observed between SGLT2i and TZD. TZD was associated with a reduced risk of ischemic stroke, cardiovascular death, and the composite kidney outcome, whereas SGLT2i reduced risks of hospitalization for heart failure, the composite kidney outcome, and all-cause mortality compared to DPP-4i. Conclusion: SGLT2i and TZD use in people with type 2 diabetes and a prior stroke was associated with reduced risks of MACE, the composite kidney outcome, and mortality compared with DPP-4i, with variations in effects on individual outcomes. (c) 2024 THE AUTHORS. Published by Elsevier Inc on behalf of Mayo Foundation for Medical Education and Research. This is an open access article under the CC BY license

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