Background
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have demonstrated cardiovascular (CV) benefits in clinical trials for patients with type 2 diabetes mellitus (T2DM). This study evaluated the real-world CV effectiveness of GLP-1RAs in patients with T2DM following acute myocardial infarction (MI).
Methods
We conducted a nationwide study utilizing data from the National Registry of Reimbursed Health Services for the period 2015-2023. Patients with nonfatal MI (ICD-10 codes I21 and I22) were included, with GLP-1RA use identified at the time of MI or within six months post-MI. GLP-1 RAs users were matched with GLP-1RAs non-users, with PSM adjustment. The primary outcome was a major adverse cardiovascular outcome, including nonfatal MI, nonfatal stroke and all-cause death. Secondary outcomes included cardiac death and recurrent ischemic events.
Results
The study cohort included 116,218 MI patients (median age: 68 years, 33.5% women), of whom 44% had T2DM. Among these, 1,127 (1.0%) were treated with GLP-1RAs at MI or within six months post-MI. The matched cohort included 8,458 patients (GLP-1RA: 1,112; nonusers: 7,346). GLP-1RA use was associated with a reduced risk of the primary composite outcome (HR: 0.76, 95%CI:0.68–0.85, P<0.001), including all-cause death (HR: 0.67, 95% CI:0.59–0.77, P<0.001) and cardiac death (HR:0.65, 95%CI:0.49–0.87, P=0.003). Patients treated with GLP-1RAs consistently showed lower mortality rates across all time points, with a 4.4% absolute difference at six months and 9.2% at 48 months. No significant differences were observed for nonfatal MI or stroke.
Conclusions
In this nationwide study, GLP-1RAs use in T2DM patients post-MI was associated with a reduced risk of major cardiovascular events, primarily attributable to a lower risk of all cause death. These real-world findings align with cardiovascular outcome trials.
