Sex Differences in Cardiovascular Effectiveness of Newer Glucose-Lowering Drugs Added to Metformin in Type 2 Diabetes Mellitus.
Aged
Biomarkers
/ blood
Blood Glucose
/ drug effects
Cardiovascular Diseases
/ diagnosis
Databases, Factual
Diabetes Mellitus, Type 2
/ blood
Dipeptidyl-Peptidase IV Inhibitors
/ therapeutic use
Down-Regulation
Drug Therapy, Combination
Female
Glucagon-Like Peptide-1 Receptor
/ agonists
Heart Disease Risk Factors
Humans
Hypoglycemic Agents
/ therapeutic use
Incretins
/ therapeutic use
Male
Metformin
/ therapeutic use
Middle Aged
Retrospective Studies
Risk Assessment
Sex Factors
Sodium-Glucose Transporter 2 Inhibitors
/ therapeutic use
Treatment Outcome
glucose‐lowering agents
major cardiovascular events
population‐based analysis
sex
type 2 diabetes mellitus
Journal
Journal of the American Heart Association
ISSN: 2047-9980
Titre abrégé: J Am Heart Assoc
Pays: England
ID NLM: 101580524
Informations de publication
Date de publication:
07 01 2020
07 01 2020
Historique:
entrez:
7
1
2020
pubmed:
7
1
2020
medline:
22
12
2020
Statut:
ppublish
Résumé
Background Randomized controlled trials showed that newer glucose-lowering agents are cardioprotective, but most participants were men. It is unknown whether benefits are similar in women. Methods and Results Among adults with type 2 diabetes mellitus not controlled with metformin with no prior use of insulin, we assessed for sex differences in the cardiovascular effectiveness and safety of sodium-glucose-like transport-2 inhibitors (SGLT-2i), glucagon-like peptide-1 receptor agonists (GLP-1RA), dipeptidyl peptidase-4 inhibitors, initiated as second-line agents relative to sulfonylureas (reference-group). We studied type 2 diabetes mellitus American adults with newly dispensed sulfonylureas, SGLT-2i, GLP-1RA, or dipeptidyl peptidase-4 inhibitors (Marketscan-Database: 2011-2017). We used multivariable Cox proportional hazards models with time-varying exposure to compare time to first nonfatal cardiovascular event (myocardial infarction/unstable angina, stroke, and heart failure), and safety outcomes between drugs users, and tested for sex-drug interactions. Among 167 254 type 2 diabetes mellitus metformin users (46% women, median age 59 years, at low cardiovascular risk), during a median 4.5-year follow-up, cardiovascular events incidence was lower in women than men (14.7 versus 16.7 per 1000-person-year). Compared with sulfonylureas, hazard ratios (HRs) for cardiovascular events were lower with GLP-1RA (adjusted HR-women: 0.57, 95% CI: 0.48-0.68; aHR-men: 0.82, 0.71-0.95), dipeptidyl peptidase-4 inhibitors (aHR-women: 0.83, 0.77-0.89; aHR-men: 0.85, 0.79-0.91) and SGLT-2i (aHR-women: 0.58, 0.46-0.74; aHR-men: 0.69, 0.57-0.83). A sex-by-drug interaction was statistically significant only for GLP-1RA (
Identifiants
pubmed: 31902326
doi: 10.1161/JAHA.119.012940
pmc: PMC6988160
doi:
Substances chimiques
Biomarkers
0
Blood Glucose
0
Dipeptidyl-Peptidase IV Inhibitors
0
GLP1R protein, human
0
Glucagon-Like Peptide-1 Receptor
0
Hypoglycemic Agents
0
Incretins
0
Sodium-Glucose Transporter 2 Inhibitors
0
Metformin
9100L32L2N
Types de publication
Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e012940Subventions
Organisme : CIHR
ID : TD3‐137716
Pays : Canada
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