Comparative effectiveness of GLP-1 receptor agonists on cardiovascular outcomes among adults with type 2 diabetes and moderate cardiovascular risk: emulation of a target trial
Authors' conclusion
Among GLP-1RAs, semaglutide and liraglutide were associated with the greatest cardiovascular risk reduction in patients with T2D at moderate cardiovascular risk.
Study context
- Population
- Adults with T2D at moderate cardiovascular risk initiating a GLP-1 RA, 01/01/2014–12/31/2021, claims dataafter inverse probability of treatment weighted (IPTW)
- Participants
- 35,572 / 4,376 / 8,843 / 33,063
- Exposure
- Dulaglutide vs exenatide vs liraglutide vs semaglutide
- Dulaglutiden = 35,572reference
- Exenatiden = 4,376
- Liraglutiden = 8,843
- Semaglutiden = 33,063
- Outcome
- Time to MACE (MACE):
- MI
- Stroke
- All-cause mortality
Methodological detailsretrospective cohort study using claims data, propensity scores, inverse probability of treatment weighted (IPTW) Cox models
- Retrospective cohort study using claims data
- Propensity scores
- Inverse probability of treatment weighted (IPTW) Cox models
Main finding
As reported in the abstract
MACE
Each group vs dulaglutideHazard ratio (95% CI)
Semaglutide
0.85(0.78–0.93)
Liraglutide
0.84(0.72–0.97)
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| Expanded MACE (MACE, hospitalization for HF, revascularization)Semaglutidevs Dulaglutide | 0.92 (0.87–0.96) | |
| All-cause mortalitySemaglutidevs Dulaglutide | 0.81 (0.71–0.92) | |
| All-cause mortalityLiraglutidevs Dulaglutide | 0.79 (0.64–0.99) | |
| StrokeSemaglutidevs Dulaglutide | 0.82 (0.70–0.97) | |
| RevascularizationSemaglutidevs Dulaglutide | 0.93 (0.88–0.99) | |
| 0.512Hazard ratio (log scale) |
Original publication
Comparative effectiveness of GLP-1 receptor agonists on cardiovascular outcomes among adults with type 2 diabetes and moderate cardiovascular risk: emulation of a target trial. Diabetes Res Clin Pract. Published 20 September 2025. doi:10.
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