Similar cardiovascular outcomes in patients with diabetes and established or high risk for coronary vascular disease treated with dulaglutide with and without baseline metformin / Desfechos cardiovasculares semelhantes em pacientes com diabetes e risco estabelecido ou alto para doença vascular coronariana tratada com dulaglutida com e sem linha de base metformina
Eur. heart j
; 42(26): 1-9, July. 2021. graf., tab.
Artigo
em Inglês
| Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP
| ID: biblio-1145686
Biblioteca responsável:
BR79.1
Localização: BR79.1
ABSTRACT
Objective Recent European Guidelines for Diabetes, Prediabetes and Cardiovascular Diseases introduced a shift in managing patients with type 2 diabetes at high risk for or established cardiovascular (CV) disease by recommending GLP-1 receptor agonists and SGLT-2 inhibitors as initial glucose-lowering therapy. This is questioned since outcome trials of these drug classes had metformin as background therapy. In this post hoc analysis, the effect of dulaglutide on CV events was investigated according to the baseline metformin therapy by means of a subgroup analysis of the Researching Cardiovascular Events with a Weekly Incretin in Diabetes (REWIND) trial. Research design and methods Patients in REWIND (n = 9901; women 46.3%; mean age 66.2 years) had type 2 diabetes and either a previous CV event (31%) or high CV risk (69%). They were randomized (11) to sc. dulaglutide (1.5 mg/weekly) or placebo in addition to standard of care. The primary outcome was the first of a composite of nonfatal myocardial infarction, nonfatal stroke, and death from cardiovascular or unknown causes. Key secondary outcomes included a microvascular composite endpoint, all-cause death, and heart failure. The effect of dulaglutide in patients with and without baseline metformin was evaluated by a Cox regression hazard model with baseline metformin, dulaglutide assignment, and their interaction as independent variables. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated by a Cox regression model with adjustments for factors differing at baseline between people with vs. without metformin, identified using the backward selection. Results Compared to patients with metformin at baseline (n = 8037; 81%), those without metformin (n = 1864; 19%) were older and slightly less obese and had higher proportions of women, prior CV events, heart failure, and renal disease. The primary outcome occurred in 976 (12%) participants with baseline metformin and in 281 (15%) without. There was no significant difference in the effect of dulaglutide on the primary outcome in patients with vs. without metformin at baseline [HR 0.92 (CI 0.811.05) vs. 0.78 (CI 0.610.99); interaction P = 0.18]. Findings for key secondary outcomes were similar in patients with and without baseline metformin. Conclusion This analysis suggests that the cardioprotective effect of dulaglutide is unaffected by the baseline use of metformin therapy.
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Coleções:
Bases de dados nacionais
/
Brasil
Contexto em Saúde:
ODS3 - Meta 3.4 Reduzir as mortes prematuras devido doenças não transmissíveis
Problema de saúde:
Doença Cardiovascular
/
Diabetes Mellitus
/
Doenças do Sistema Endócrino
Base de dados:
Sec. Est. Saúde SP
/
SESSP-IDPCPROD
Assunto principal:
Doenças Vasculares
/
Doenças Cardiovasculares
/
Diabetes Mellitus
Tipo de estudo:
Ensaio clínico controlado
/
Estudo de etiologia
/
Guia de prática clínica
/
Estudo prognóstico
/
Fatores de risco
Idioma:
Inglês
Revista:
Eur. heart j
Ano de publicação:
2021
Tipo de documento:
Artigo
Instituição/País de afiliação:
Baker Heart and Diabetes Institute/AU
/
Department of Internal Medicine Latvijas Universitate/LV
/
Division of Cardiology Medical University of South Carolina/US
/
Eli Lilly and Company/US
/
Instituto Cardiovascular de Rosario/PY
/
Instituto Dante Pazzanese de Cardiologia/BR
/
Karolinska Institutet/SE
/
McMaster University Medical Center/CA
/
Memphis Veterans Affairs Medical Center/US
/
National Medical Research Center of Cardiology Ulitsa Ostrovityanova/RU