Cardioprotective glucose-lowering drugs, statins, and secondary major adverse cardiovascular events: a nationwide cohort study of individuals with type 2 diabetes and cardiovascular disease
Authors' conclusion
In individuals with type 2 diabetes and established cardiovascular disease, treatment with a cardioprotective glucose-lowering drug and statin in combination was associated with lower risk of secondary major adverse cardiovascular events than using either drug alone. This is important given the persistently suboptimal uptake of both drug classes in real-world practice. Some biases can never be completely excluded in real-world pharmacotherapy use studies such as this one, including confounding by indication, time-related or immortal time biases, and shifting standards of care, rendering causal interpretation unattainable; however, our results seemed consistent across numerous sensitivity analyses and designs.
Study context
- Population
- Individuals with T2D and established CVD, December 2012 through 2021, Denmarkactive comparator cohort
- Participants
- 15,404 individuals
- Exposure
- Cardioprotective glucose-lowering drug, statin, or both vs no cardioprotective drug
- Outcome
- New MACE:
- MI
- Stroke
- Cardiovascular death
- Follow-up
- Mean 2.7 (active comparator) and 4.7 (time-varying) years
Methodological detailsactive comparator cohort, time-varying cohort, national Danish health registers
- Active comparator cohort
- Time-varying cohort
- National Danish health registers
Main finding
As reported in the abstract
- MACE events, active comparator cohort
- 1,843
- p for interaction between cardioprotective glucose-lowering drug and statin
- > 0.05
Observational data: associations, not effects.
Further findings
| Outcome | HR (CI) | |
|---|---|---|
| MACE, time-varying cohort (n=76,853), multivariable adjusted · mean 4.7 years of follow-upCardioprotective glucose-lowering drugvs No cardioprotective drug | 0.77 (0.69–0.86) | |
| MACE, time-varying cohort (n=76,853), multivariable adjusted · mean 4.7 years of follow-upStatinvs No cardioprotective drug | 0.73 (0.70–0.75) | |
| MACE, time-varying cohort (n=76,853), multivariable adjusted · mean 4.7 years of follow-upCardioprotective glucose-lowering drug and statinvs No cardioprotective drug | 0.57 (0.54–0.60) | |
| 0.512Hazard ratio (log scale) |
MACE, active comparator cohort restricted to individuals entering observation 2019–2021
- Corresponding HRs estimated in the restricted cohort, with reduced statistical power
Interaction between cardioprotective glucose-lowering drug and statin
- P for interaction, both cohorts
- > 0.05
Patients with MACE · mean 2.7 and 4.7 years of follow-up
- Active comparator cohort
- 1,843
- Time-varying cohort
- 23,051
Original publication
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