Abstract：
The benefits of new glucose-lowering agents on cardiovascular disease have been demonstrated in randomized clinical trials. However, more evidence is required to assess the additive value of a combined therapy based on sodium-glucose transporter inhibitors (SGLT2i) and glucagon-like peptide receptor agonists (GLP1ra) in a real-world population.
A nonconcurrent prospective study was conducted using integrated electronic medical records from primary care and hospitals obtained through \"big data\" technologies in a healthy area in Galicia. The study involved patients who were given SGLT2i, GLP1ra, or both treatments between January 2018 and June 2022 and were categorized as either mono- or combined therapy (SGLT2i, GLP1ra, or both). The cumulative risk for different events: hospitalization or mortality, or both, for 1) coronary artery disease, 2) heart failure, 3) cerebrovascular accident, and all-cause mortality were represented by Kaplan-Meier curves and multivariate Cox regression analysis to obtain the hazard ratio (HR) and (95% confidence interval [CI]). Validation was performed in a subpopulation with propensity score matching.
The patients (15,549) who were included were median (standard deviation) 68 (12) years old, with 41% of them being female and 46% experiencing obesity. The median (interquartile range) of follow-up was 19 (8-33) months. The Kaplan-Meier analysis determined that the cumulative risk for coronary artery disease and cerebrovascular accident events was similar among the 3 different therapy groups. However, the combined therapy vs SGLT2i reduced the risk of heart failure events (HR 0.69; 95% CI, 0.56-0.87) or all-cause mortality (HR 0.68; 95% CI, 0.54-0.86). Multivariate Cox regression analysis, after matching with a propensity score, confirmed the benefits of combined therapy regarding SGLT2i or GLP1ra monotherapy.
Compared with SGLT2i or GLP1ra alone, combined therapy SGLT2i + GLP1ra reduces heart failure risk and all-cause mortality in a real-world population.
A nonconcurrent prospective study was conducted using integrated electronic medical records from primary care and hospitals obtained through \"big data\" technologies in a healthy area in Galicia. The study involved patients who were given SGLT2i, GLP1ra, or both treatments between January 2018 and June 2022 and were categorized as either mono- or combined therapy (SGLT2i, GLP1ra, or both). The cumulative risk for different events: hospitalization or mortality, or both, for 1) coronary artery disease, 2) heart failure, 3) cerebrovascular accident, and all-cause mortality were represented by Kaplan-Meier curves and multivariate Cox regression analysis to obtain the hazard ratio (HR) and (95% confidence interval [CI]). Validation was performed in a subpopulation with propensity score matching.
The patients (15,549) who were included were median (standard deviation) 68 (12) years old, with 41% of them being female and 46% experiencing obesity. The median (interquartile range) of follow-up was 19 (8-33) months. The Kaplan-Meier analysis determined that the cumulative risk for coronary artery disease and cerebrovascular accident events was similar among the 3 different therapy groups. However, the combined therapy vs SGLT2i reduced the risk of heart failure events (HR 0.69; 95% CI, 0.56-0.87) or all-cause mortality (HR 0.68; 95% CI, 0.54-0.86). Multivariate Cox regression analysis, after matching with a propensity score, confirmed the benefits of combined therapy regarding SGLT2i or GLP1ra monotherapy.
Compared with SGLT2i or GLP1ra alone, combined therapy SGLT2i + GLP1ra reduces heart failure risk and all-cause mortality in a real-world population.
摘要：
背景：在随机临床试验中已经证明了新型降糖药对心血管疾病的益处。然而,在现实人群中,需要更多证据来评估基于钠-葡萄糖转运蛋白抑制剂(SGLT2i)和胰高血糖素样肽受体激动剂(GLP1ra)的联合治疗的累加价值.
方法：在加利西亚的一个健康地区，使用来自初级保健和医院的通过“大数据”技术获得的综合电子病历进行非并行前瞻性研究。该研究涉及接受SGLT2i治疗的患者，GLP1ra,或两种治疗在2018年1月至2022年6月之间进行，并分为单一或联合治疗（SGLT2i，GLP1ra,或两者)。不同事件的累积风险：a）冠状动脉疾病的住院和/或死亡率，b)心力衰竭,c)脑血管意外,和全因死亡率用KaplanMeier曲线和多变量Cox回归分析表示,以获得危险率(HR)和(95%置信区间(CI)).在具有倾向评分匹配的亚群中进行验证。
结果：纳入的患者（15,549）为68（12）岁，其中41%是女性，46%患有肥胖症。随访的中位数（四分位距）为19（8-33）个月。Kaplan-Meier分析确定，在3个不同的治疗组中，冠状动脉疾病和脑血管意外事件的累积风险相似。然而,联合疗法与SGLT2i降低了风险，心力衰竭事件(HR:0.69[95%CI;0.56-0.87])或全因死亡率(HR:0.68[95%CI;0.54-0.86]).多变量Cox回归分析，在与倾向评分匹配后，确认SGLT2i或GLP1ra单药治疗联合治疗的益处。
结论：与单独的SGLT2i或GLP1ra相比，SGLT2i+GLP1ra联合治疗可降低真实世界人群的心力衰竭风险和全因死亡率.
方法：在加利西亚的一个健康地区，使用来自初级保健和医院的通过“大数据”技术获得的综合电子病历进行非并行前瞻性研究。该研究涉及接受SGLT2i治疗的患者，GLP1ra,或两种治疗在2018年1月至2022年6月之间进行，并分为单一或联合治疗（SGLT2i，GLP1ra,或两者)。不同事件的累积风险：a）冠状动脉疾病的住院和/或死亡率，b)心力衰竭,c)脑血管意外,和全因死亡率用KaplanMeier曲线和多变量Cox回归分析表示,以获得危险率(HR)和(95%置信区间(CI)).在具有倾向评分匹配的亚群中进行验证。
结果：纳入的患者（15,549）为68（12）岁，其中41%是女性，46%患有肥胖症。随访的中位数（四分位距）为19（8-33）个月。Kaplan-Meier分析确定，在3个不同的治疗组中，冠状动脉疾病和脑血管意外事件的累积风险相似。然而,联合疗法与SGLT2i降低了风险，心力衰竭事件(HR:0.69[95%CI;0.56-0.87])或全因死亡率(HR:0.68[95%CI;0.54-0.86]).多变量Cox回归分析，在与倾向评分匹配后，确认SGLT2i或GLP1ra单药治疗联合治疗的益处。
结论：与单独的SGLT2i或GLP1ra相比，SGLT2i+GLP1ra联合治疗可降低真实世界人群的心力衰竭风险和全因死亡率.
