Similar cardiovascular outcomes in patients with diabetes and established or high risk for coronary vascular disease treated with dulaglutide with and without baseline metformin
Objective Recent European Guidelines for Diabetes, Prediabetes and Cardiovascular Diseases introduced a shift in managing patients with type 2 diabetes at high risk for or established cardiovascular (CV) disease by recommending GLP-1 receptor agonists and SGLT-2 inhibitors as initial glucose-lower...
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European Society of Cardiology
2021-07-07
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Ferrannini, Giulia Gerstein, Hertzel Colhoun, Helen Martina Dagenais, Gilles R. Diaz, Rafael Dyal, Leanne Lakshmanan, Mark Mellbin, Linda Probstfield, Jeffrey Riddle, Matthew Casey Shaw, Jonathan Edward Avezum, Alvaro Basile, Jan Neil Cushman, William C. Jansky, Petr Keltai, Mátyás Lanas, Fernando Leiter, Lawrence Alan Lopez-Jaramillo, Patricio Pais, Prem Pīrāgs, Valdis Pogosova, Nana Raubenheimer, Peter Johann Huey-Herng Sheu, Wayne Rydén, Lars Masira 2022-02-21T15:21:53Z 2022-02-21T15:21:53Z 2021-07-07 Digital Objective Recent European Guidelines for Diabetes, Prediabetes and Cardiovascular Diseases introduced a shift in managing patients with type 2 diabetes at high risk for or established cardiovascular (CV) disease by recommending GLP-1 receptor agonists and SGLT-2 inhibitors as initial glucose-lowering therapy. This is questioned since outcome trials of these drug classes had metformin as background therapy. In this post hoc analysis, the effect of dulaglutide on CV events was investigated according to the baseline metformin therapy by means of a subgroup analysis of the Researching Cardiovascular Events with a Weekly Incretin in Diabetes (REWIND) trial. Research design and methods Patients in REWIND (n = 9901; women: 46.3%; mean age: 66.2 years) had type 2 diabetes and either a previous CV event (31%) or high CV risk (69%). They were randomized (1:1) to sc. dulaglutide (1.5 mg/weekly) or placebo in addition to standard of care. The primary outcome was the first of a composite of nonfatal myocardial infarction, nonfatal stroke, and death from cardiovascular or unknown causes. Key secondary outcomes included a microvascular composite endpoint, all-cause death, and heart failure. The effect of dulaglutide in patients with and without baseline metformin was evaluated by a Cox regression hazard model with baseline metformin, dulaglutide assignment, and their interaction as independent variables. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated by a Cox regression model with adjustments for factors differing at baseline between people with vs. without metformin, identified using the backward selection. Results Compared to patients with metformin at baseline (n = 8037; 81%), those without metformin (n = 1864; 19%) were older and slightly less obese and had higher proportions of women, prior CV events, heart failure, and renal disease. The primary outcome occurred in 976 (12%) participants with baseline metformin and in 281 (15%) without. There was no significant difference in the effect of dulaglutide on the primary outcome in patients with vs. without metformin at baseline [HR 0.92 (CI 0.81–1.05) vs. 0.78 (CI 0.61–0.99); interaction P = 0.18]. Findings for key secondary outcomes were similar in patients with and without baseline metformin. Conclusion This analysis suggests that the cardioprotective effect of dulaglutide is unaffected by the baseline use of metformin therapy. Ciencias Médicas y de la Salud 11 p application/pdf https://doi.org/10.1093/eurheartj/ehaa777 https://repositorio.udes.edu.co/handle/001/6070 eng European Society of Cardiology Reino Unido 2573 26 2565 42 Giulia Ferrannini, Hertzel Gerstein, Helen Martina Colhoun, Gilles R Dagenais, Rafael Diaz, Leanne Dyal, Mark Lakshmanan, Linda Mellbin, Jeffrey Probstfield, Matthew Casey Riddle, Jonathan Edward Shaw, Alvaro Avezum, Jan Neil Basile, William C Cushman, Petr Jansky, Mátyás Keltai, Fernando Lanas, Lawrence Alan Leiter, Patricio Lopez-Jaramillo, Prem Pais, Valdis Pīrāgs, Nana Pogosova, Peter Johann Raubenheimer, Wayne Huey-Herng Sheu, Lars Rydén, Similar cardiovascular outcomes in patients with diabetes and established or high risk for coronary vascular disease treated with dulaglutide with and without baseline metformin, European Heart Journal, Volume 42, Issue 26, 7 July 2021, Pages 2565–2573, https://doi.org/10.1093/eurheartj/ehaa777 Scopus European Heart Journal Copyright © The Authors, European Society of Cardiology, 2021 info:eu-repo/semantics/closedAccess Atribución-NoComercial 4.0 Internacional (CC BY-NC 4.0) https://creativecommons.org/licenses/by-nc/4.0/ https://academic.oup.com/eurheartj/article-abstract/42/26/2565/5983740?redirectedFrom=fulltext Cardiovascular disease GLP-1-based therapy Metformin Mortality Morbidity Similar cardiovascular outcomes in patients with diabetes and established or high risk for coronary vascular disease treated with dulaglutide with and without baseline metformin Artículo de revista http://purl.org/coar/resource_type/c_6501 Text info:eu-repo/semantics/article http://purl.org/redcol/resource_type/ART info:eu-repo/semantics/publishedVersion Todas las Audiencias Publication http://purl.org/coar/access_right/c_14cb http://purl.org/coar/version/c_970fb48d4fbd8a85 |
| institution |
Universidad EIA |
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d_repositorio.udes.edu.co-DSPACE |
| title |
Similar cardiovascular outcomes in patients with diabetes and established or high risk for coronary vascular disease treated with dulaglutide with and without baseline metformin |
| spellingShingle |
Similar cardiovascular outcomes in patients with diabetes and established or high risk for coronary vascular disease treated with dulaglutide with and without baseline metformin Ferrannini, Giulia Gerstein, Hertzel Colhoun, Helen Martina Dagenais, Gilles R. Diaz, Rafael Dyal, Leanne Lakshmanan, Mark Mellbin, Linda Probstfield, Jeffrey Riddle, Matthew Casey Shaw, Jonathan Edward Avezum, Alvaro Basile, Jan Neil Cushman, William C. Jansky, Petr Keltai, Mátyás Lanas, Fernando Leiter, Lawrence Alan Lopez-Jaramillo, Patricio Pais, Prem Pīrāgs, Valdis Pogosova, Nana Raubenheimer, Peter Johann Huey-Herng Sheu, Wayne Rydén, Lars Ferrannini, Giulia Gerstein, Hertzel Colhoun, Helen Martina Dagenais, Gilles R. Diaz, Rafael Dyal, Leanne Lakshmanan, Mark Mellbin, Linda Probstfield, Jeffrey Riddle, Matthew Casey Shaw, Jonathan Edward Avezum, Alvaro Basile, Jan Neil Cushman, William C. Jansky, Petr Keltai, Mátyás Lanas, Fernando Leiter, Lawrence Alan Lopez-Jaramillo, Patricio Pais, Prem Pīrāgs, Valdis Pogosova, Nana Raubenheimer, Peter Johann Huey-Herng Sheu, Wayne Rydén, Lars Masira Cardiovascular disease GLP-1-based therapy Metformin Mortality Morbidity |
| title_short |
Similar cardiovascular outcomes in patients with diabetes and established or high risk for coronary vascular disease treated with dulaglutide with and without baseline metformin |
| title_full |
Similar cardiovascular outcomes in patients with diabetes and established or high risk for coronary vascular disease treated with dulaglutide with and without baseline metformin |
| title_fullStr |
Similar cardiovascular outcomes in patients with diabetes and established or high risk for coronary vascular disease treated with dulaglutide with and without baseline metformin |
| title_full_unstemmed |
Similar cardiovascular outcomes in patients with diabetes and established or high risk for coronary vascular disease treated with dulaglutide with and without baseline metformin |
| title_sort |
similar cardiovascular outcomes in patients with diabetes and established or high risk for coronary vascular disease treated with dulaglutide with and without baseline metformin |
| author |
Ferrannini, Giulia Gerstein, Hertzel Colhoun, Helen Martina Dagenais, Gilles R. Diaz, Rafael Dyal, Leanne Lakshmanan, Mark Mellbin, Linda Probstfield, Jeffrey Riddle, Matthew Casey Shaw, Jonathan Edward Avezum, Alvaro Basile, Jan Neil Cushman, William C. Jansky, Petr Keltai, Mátyás Lanas, Fernando Leiter, Lawrence Alan Lopez-Jaramillo, Patricio Pais, Prem Pīrāgs, Valdis Pogosova, Nana Raubenheimer, Peter Johann Huey-Herng Sheu, Wayne Rydén, Lars Ferrannini, Giulia Gerstein, Hertzel Colhoun, Helen Martina Dagenais, Gilles R. Diaz, Rafael Dyal, Leanne Lakshmanan, Mark Mellbin, Linda Probstfield, Jeffrey Riddle, Matthew Casey Shaw, Jonathan Edward Avezum, Alvaro Basile, Jan Neil Cushman, William C. Jansky, Petr Keltai, Mátyás Lanas, Fernando Leiter, Lawrence Alan Lopez-Jaramillo, Patricio Pais, Prem Pīrāgs, Valdis Pogosova, Nana Raubenheimer, Peter Johann Huey-Herng Sheu, Wayne Rydén, Lars Masira |
| author_facet |
Ferrannini, Giulia Gerstein, Hertzel Colhoun, Helen Martina Dagenais, Gilles R. Diaz, Rafael Dyal, Leanne Lakshmanan, Mark Mellbin, Linda Probstfield, Jeffrey Riddle, Matthew Casey Shaw, Jonathan Edward Avezum, Alvaro Basile, Jan Neil Cushman, William C. Jansky, Petr Keltai, Mátyás Lanas, Fernando Leiter, Lawrence Alan Lopez-Jaramillo, Patricio Pais, Prem Pīrāgs, Valdis Pogosova, Nana Raubenheimer, Peter Johann Huey-Herng Sheu, Wayne Rydén, Lars Ferrannini, Giulia Gerstein, Hertzel Colhoun, Helen Martina Dagenais, Gilles R. Diaz, Rafael Dyal, Leanne Lakshmanan, Mark Mellbin, Linda Probstfield, Jeffrey Riddle, Matthew Casey Shaw, Jonathan Edward Avezum, Alvaro Basile, Jan Neil Cushman, William C. Jansky, Petr Keltai, Mátyás Lanas, Fernando Leiter, Lawrence Alan Lopez-Jaramillo, Patricio Pais, Prem Pīrāgs, Valdis Pogosova, Nana Raubenheimer, Peter Johann Huey-Herng Sheu, Wayne Rydén, Lars Masira |
| building |
Repositorio digital |
| topic |
Cardiovascular disease GLP-1-based therapy Metformin Mortality Morbidity |
| topic_facet |
Cardiovascular disease GLP-1-based therapy Metformin Mortality Morbidity |
| publishDate |
2021-07-07 |
| language |
English |
| publisher |
European Society of Cardiology |
| physical |
11 p |
| format |
Artículo de revista |
| description |
Objective
Recent European Guidelines for Diabetes, Prediabetes and Cardiovascular Diseases introduced a shift in managing patients with type 2 diabetes at high risk for or established cardiovascular (CV) disease by recommending GLP-1 receptor agonists and SGLT-2 inhibitors as initial glucose-lowering therapy. This is questioned since outcome trials of these drug classes had metformin as background therapy. In this post hoc analysis, the effect of dulaglutide on CV events was investigated according to the baseline metformin therapy by means of a subgroup analysis of the Researching Cardiovascular Events with a Weekly Incretin in Diabetes (REWIND) trial.
Research design and methods
Patients in REWIND (n = 9901; women: 46.3%; mean age: 66.2 years) had type 2 diabetes and either a previous CV event (31%) or high CV risk (69%). They were randomized (1:1) to sc. dulaglutide (1.5 mg/weekly) or placebo in addition to standard of care. The primary outcome was the first of a composite of nonfatal myocardial infarction, nonfatal stroke, and death from cardiovascular or unknown causes. Key secondary outcomes included a microvascular composite endpoint, all-cause death, and heart failure. The effect of dulaglutide in patients with and without baseline metformin was evaluated by a Cox regression hazard model with baseline metformin, dulaglutide assignment, and their interaction as independent variables. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated by a Cox regression model with adjustments for factors differing at baseline between people with vs. without metformin, identified using the backward selection.
Results
Compared to patients with metformin at baseline (n = 8037; 81%), those without metformin (n = 1864; 19%) were older and slightly less obese and had higher proportions of women, prior CV events, heart failure, and renal disease. The primary outcome occurred in 976 (12%) participants with baseline metformin and in 281 (15%) without. There was no significant difference in the effect of dulaglutide on the primary outcome in patients with vs. without metformin at baseline [HR 0.92 (CI 0.81–1.05) vs. 0.78 (CI 0.61–0.99); interaction P = 0.18]. Findings for key secondary outcomes were similar in patients with and without baseline metformin.
Conclusion
This analysis suggests that the cardioprotective effect of dulaglutide is unaffected by the baseline use of metformin therapy.
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| url |
https://repositorio.udes.edu.co/handle/001/6070 |
| url_str_mv |
https://repositorio.udes.edu.co/handle/001/6070 |
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1763049300758102016 |
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11.2563715 |
