Real-life use of novel glucose lowering agents in coronary artery disease

Presented at the EASD 2023 by: Pia Lundman, MD, PhD - Stockholm, Sweden

Introduction and methods

Several RCTs have confirmed the preventive cardiovascular effects of SGLT2i and GLP-1RA in patients with T2D and CVD. The current study investigated the prescription pattern of novel glucose lowering drugs (defined in the study as SGLT2i and GLP-1RA) in patients with T2D and CAD in the national wide SWEDEHEART-registry.

A total of 38,671 patients from Sweden were included from 2010 to 2021 in the analysis. All patients had T2D and were admitted for coronary angiography (71% with acute MI, 29% with stable CAD). Information Mortality was followed until December 2021.

Main results

• The prescription rates for novel glucose lowering drugs increased rapidly from 2016 to 2021 (7% in 2016 to 47% in 2021).
• The largest increase was seen with prescription of SGLT2i (from 4% in 2016 to 38% in 2021). The increase in prescription of GLP-1RA remained lower (4% in 2016 to 15% in 2021).
• Other trends that were notices were a slight decrease in use of insulin and absence of glucose lowering treatment, a large decrease in use of sulfonylurea, and a slight increase in use of metformin.
• Patients receiving prescriptions for novel glucose lowering drugs were younger (66 vs. 68 years), more often man (73% vs. 67%), had less frequent HF (5.0% vs. 6.8%) and less frequent previous MI (7.7% vs. 10.5%) , compared to patients receiving other glucose lowering drugs.
• Adjusted long-term mortality was higher in patients on other glucose lowering drug compared to those on novel glucose lowering drugs (HR 1.22, 95%CI 1.09-1.37).

Conclusion

Results of this real-life study showed a rapid increase in the use of SGLT2i and GLP1-RA in patients with T2D and CAD in Sweden. “This is an encouraging adaption towards guideline directed medical therapies, where however the use of GLP-1RA is lower than the use of SGLT2i”, said Pia Lundman.

- Our reporting is based on the information provided at the EASD 2023 -