Author + information
- Suzanne Arnold,
- Silvio Inzucchi,
- Fengming Tang,
- Darren McGuire,
- Sanjeev N. Mehta,
- Abhinav Goyal,
- Thomas Maddox,
- Laurence Sperling,
- Daniel Einhorn,
- Nathan Wong and
- Mikhail Kosiborod
Background: Recent trials have shown improved CV outcomes in patients with type 2 diabetes (T2D) treated with specific glucose-lowering medications, but the potential real-world impact of such strategies is largely unknown. Liraglutide, a GLP-1 receptor agonist (RA), reduced the incidence of CV death and MACE among patients with T2D at high CV risk in the LEADER trial. We evaluated the prevailing use and potential impact of liraglutide (and other GLP-1 RAs) among patients in the DCR.
Methods: DCR is a US-based outpatient registry of patients with diabetes seen in cardiology, endocrinology, and primary care practices and currently encompasses 374 practices and 5114 providers. Potential LEADER-eligible patients were those with 1) T2D with HbA1c ≥7% and 2) ≥50 years old and CV disease or CKD 3 or greater; or ≥60 years old and ≥1 additional CV risk factor (HTN or LV dysfunction).
Results: Among 100,267 patients with T2D and HbA1c data, 85,519 (85%) were potentially LEADER-eligible. Mean age was 71 y, 56% were men, mean HbA1c was 8.4%. There were 4700 of these patients (5.5%) who were treated with a GLP-1 RA—exenatide 50%, liraglutide 43%, dulaglutide 5%, albiglutide 3%. GLP-1 RA medications were more commonly used in patients seen by endocrinologists vs cardiologists and PCPs (9.2% vs 5.3% vs 2.2% of patients, p<0.001). LEADER-eligible patients treated (vs not) with GLP-1 RAs were more likely to be younger (67 vs 71 y), never smokers (52% vs 49%), have higher BMIs (35 vs 32 kg/m2), and were less likely to have had an MI (15% vs. 17%) or CHF (27% vs. 33%; all p<0.001). Assuming similar risk reductions as in LEADER, if all potentially eligible patients in DCR were treated with liraglutide (or other GLP-1 RAs, if a class effect), 323 CV deaths and 242 MIs may have been prevented for each year of treatment.
Conclusions: In a large US-based outpatient registry, we found that the majority of outpatients with T2D met the main eligibility criteria for LEADER, but GLP-1 RAs were rarely used in these patients. Broader use of liraglutide (or other GLP-1 RAs) in eligible patients could significantly reduce CV morbidity/mortality. Greater awareness of the CV impact of T2D agents is needed to further optimize treatment of these high-risk patients.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Updates in Stable Ischemic Heart Disease
Abstract Category: 3. Acute and Stable Ischemic Heart Disease: Therapy
Presentation Number: 1125-307
- 2017 American College of Cardiology Foundation