Liraglutide-empagliflozin combination therapy improves myocardial deformation, cutting cardiovascular events and costs in type 2 diabetes.

Patients with type 2 diabetes mellitus (T2DM) face a significantly elevated risk of cardiovascular disease (CVD), which remains a leading cause of morbidity and mortality. Traditional glucose-lowering therapies often fall short in providing comprehensive cardiovascular protection. Recent evidence highlights the cardioprotective benefits of GLP-1 receptor agonists (GLP-1RAs) like liraglutide and SGLT2 inhibitors (SGLT2i) like empagliflozin individually. However, the long-term cardiovascular and economic outcomes of their combined use, particularly linked to early improvements in myocardial deformation (a sensitive marker of cardiac function), have been less clear.

Researchers enrolled 336 consecutive T2DM participants, aged 60 ± 10 years (75% males), into four treatment groups: insulin, liraglutide, empagliflozin, and liraglutide + empagliflozin. Left ventricular global longitudinal strain (LVGLS) was measured at baseline and 6 months using echocardiography. Patients were then followed for 6 years to record the incidence of a composite endpoint of non-fatal cardiovascular events (myocardial infarction, heart failure hospitalization, ischaemic stroke, coronary revascularization). Multivariable Cox regression models assessed associations, and a cost analysis was also performed.

At 6 months, LVGLS significantly increased (P = 0.020), with the most substantial improvement observed in the combination group compared to insulin, GLP-1RA, and SGLT2i monotherapy groups (P < 0.05). Over the 6-year follow-up, 91 cardiovascular events were recorded across all groups. > Combination therapy with liraglutide and empagliflozin was associated with the lowest risk of events, demonstrating significantly reduced hazard ratios compared to other groups: HR = 4.36 (95% CI: 2.04-9.33, P < 0.001) vs. insulin; HR = 2.45 (95% CI: 1.06-5.64, P = 0.035) vs. GLP-1RA monotherapy; and HR = 3.07 (95% CI: 1.38-6.81, P = 0.006) vs. SGLT2i monotherapy. Furthermore, in the combination group, the early improvement in LVGLS independently predicted a reduced event risk (HR = 0.89, 95% CI: 0.79-0.98, P = 0.040). Economically, the combination group also showed the lowest mean cost per patient per month at 175€ (95% CI: 30-321€), significantly lower than insulin (691€), GLP-1RA (224€), and SGLT2i (528€) monotherapies.