GLP-1 Agonists and SGLT2 Inhibitors: Which is Better for Heart Health in Diabetes?

Patients with Type 2 Diabetes Mellitus (T2DM) face a significantly elevated risk of cardiovascular disease (CVD), including heart attack, stroke, and heart failure. While both Glucagon-Like Peptide 1 Receptor Agonists (GLP-1 RAs) and Sodium-Glucose Cotransporter 2 Inhibitors (SGLT2is) have demonstrated cardiovascular benefits in clinical trials, a direct, large-scale comparison of their real-world effectiveness across various cardiovascular outcomes has been lacking. This study aimed to compare the cardiovascular effectiveness of GLP-1 RAs and SGLT2is in a broad population of patients with T2DM.

The study revealed distinct cardiovascular benefit profiles for each drug class. GLP-1 RAs demonstrated a 22% reduction in Major Adverse Cardiovascular Events (MACE) compared to a 18% reduction with SGLT2is (p<0.001 for both vs. control). Specifically, GLP-1 RAs were associated with a 25% lower risk of stroke (p<0.001), whereas SGLT2is showed only a 10% reduction (p<0.05). Conversely, SGLT2is exhibited superior efficacy in preventing heart failure hospitalization, achieving a 34% reduction compared to 20% with GLP-1 RAs (p<0.001 for both). > SGLT2is provided a 40% reduction in a composite renal outcome (e.g., sustained decline in eGFR, end-stage renal disease), significantly outperforming GLP-1 RAs which showed a 15% reduction (p<0.001 vs. p<0.05 respectively). Both classes similarly reduced cardiovascular mortality, with SGLT2is showing a 17% reduction (p<0.005) and GLP-1 RAs a 15% reduction (p<0.01). Additionally, GLP-1 RAs led to an average 6.5 kg greater weight reduction compared to SGLT2is.