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EASD Rapport. Underbehandling av SGLT2i/GLP1 vid hjärtkärlsjd

Underbehandling av nya diabetesläkemedel vid hjärtkärlsjukdom

Viveca Ritzinger, kardiologi och disputerad, vid Ljungby lasarett, har följt upp användningen av SGLT2-hämmare, som Jardiance (empagliflozin), och GLP1-analoger, som Ozempic (semaglutid) hos kranskärls- och diabetespatienter.

Patienter med kranskärlssjukdom och samtidig diabetes får mer sällan nyare hjärtskyddande glukossänkande läkemedel om de har högre kardiovaskulär riskprofil än en lägre sådan risk.

Forskarna konstaterar att andelen kranskärlspatienter som samtidigt har typ 2 diabetes och står på någon av de två läkemedelstyperna har ökat från runt
• 6 procent 2017 till 47 procent år 2021.

De patienter som har förskrivits SGLT2-hämmare och GLP1-analoger är i snitt är två år yngre och lite oftare fria från tidigare behov av sjukvård för hjärtsvikt, stroke och hjärtinfarkt än de patienter som inte fått läkemedlen. Dessa nya hjärtskyddande läkemedel förskrivs mer ofta till dem med mer okomplicerad hjärtsjukdom.

Resultaten baseras på uppföljning av nästan 38 700 patienter. Samtliga hade diabetes, mestadels typ 2-diabetes, och alla hade genomgått kranskärlsröntgen under åren 2010 till 2021 och därmed följts i registret Scaar, Svenska koronar- och angioplastikregistret.

Läs EASD abstract:

Real-life use of novel glucose lowering agents in coronary artery disease: experience from the SWEDHEART-registry

V. Ritsinger¹, K. Avander², B. Lagerqvist³, P. Lundman², A. Norhammar¹;
¹Unit of Cardiology, Department of medicine, MedS, Karolinska Institutet, Stockholm, Sweden, ²Department of Clinical Sciences, Karolinska Insitutet, Danderyds Hospital, Stockholm, Sweden, ³Uppsala Clinical R Uppsala Clinical Research Center, Uppsala University, Department of Medical Sciences, Uppsala, Sweden.

Thursday, October 5, 2023, 3:30 PM-3:45 PM

Disclosures: V. Ritsinger:None.

Acknowledgement: The Swedish Heart and Lung foundation

Background and aims:
Recently SGLT2i and GLP-1 RA have demonstrated preventive cardiovascular effects. We explored trends and real-life use of novel glucose lowering drugs (GLD) in patients with diabetes and coronary artery disease (CAD) and these patients’ prognosis in a national perspective in Sweden.

Materials and methods:
All patients with diabetes and CAD admitted for coronary angiography in 2010-2021 reported in the Swedish angiography and angioplasty registry (SCAAR) were included (70% with acute myocardial infarction). Information on GLD dispension up to 6 months after the coronary angiography was collected from the Prescribed Drug Registry and grouped into classes. Death was followed until December 2021. Mortality was assessed by Cox proportional survival analysis with novel cardioprotective glucose lowering agents as a reference.

Results:
Of 38 671 patients, mean age was 68.6 years and 67.3% (n=26 017) were men. Use of novel GLD (Figure) increased rapidly from the year 2016 with a continuously high rise (proportion 8% to 48%). This was mainly driven by the use of SGLT2i (from 4% to 38%) and less of GLP-1 RA (4% to 15%). Use of insulin decreased slightly and sulfonylurea decreased dramatically while use of metformin slightly increased.

Patients who received the new agents (SGLT2; n=3191 and GLP-1 RA; n=1570) were younger (mean age 66 [SD10] vs. 68 years [SD10]), more often men (72.8%; n=3465 vs. 67.1%; n=17 427) and with less frequent heart failure (5.0%; n=239 vs. 6.8%; n=1770) and previous myocardial infarction (7.7%; n=367 vs. 10.5%; n=2736) compared to patients on other GLD than SGLT2i or GLP-1 RA (n=25 967).

Cumulative unadjusted long-term mortality rate was highest in patients with no GLD-treatment followed by other GLD treatment and was lowest in those with new GLD. All-cause death within 1 year occurred in 1.7% (n=79) of patients with SGLT2i and/or GLP-1 RA compared to 4.5% (n=1114) in patients without new cardioprotective agents whose adjusted associated risk for all-cause death was higher, HR 1.22 (95%CI 1.09-1.37).

Conclusion:
There is an encouraging fast uptake of novel cardioprotective glucose lowering agents in patients with diabetes and CAD in Sweden. However, there is an inequality signal, that novel agents are being more often prescribed to a population with lower cardiovascular risk with an associated better outcome and less often to those at high risk for new events. This may be one explanation for the lower mortality rate. An increased awareness is needed in order to use effective cardioprotective treatment also in high-risk populations. Figure: Trends in glucose lowering agents in CAD patients.

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