Glucose-Lowering Medications Reduce CV Risk in Hispanic Patients With Diabetes

Hispanic individuals with type 2 diabetes (T2D) treated with sodium-glucose cotransporter 2 inhibitors may experience a lowered risk for major adverse cardiovascular events (MACEs), according to findings published in the Journal of the American Heart Association.

Investigators sought to determine if Hispanic patients achieve renal and cardiovascular benefits when treated with sodium-glucose cotransporter 2 inhibitors (SGLT2) and glucagon-like peptide-1 receptor agonists (GLP-1RAs).

The investigators searched the Cochrane Central Register of Controlled Trials, Embase, and PubMed from inception into March 2021. They included 11 trials (N=92,060) reporting composite renal outcomes, cardiovascular hospitalization/death for heart failure, and MACEs stratified by ethnicity among individuals with T2D. Data was extracted by 2 independent reviewers, and the Cochrane risk-of-bias tool was used to assess risk of bias (all included trials judged as low-risk). Additional inclusion criteria were trials investigating SGLT2 inhibitors, GLP-1RAs, and dipeptidyl peptidase-4 (DPP-4) inhibitors among individuals with T2D.

There was a statistically significant difference in treatment effects on MACE risk in 3 trials reporting on SGLT2 inhibitor use between Hispanic (hazard ratio [HR], 0.70; 95% CI, 0.54-0.91) vs non-Hispanic (HR, 0.96; 95% CI, 0.86-1.07; P_interaction =.03) groups, with the exceptions of risk for the composite renal outcome (P_interaction =.31) and risk for cardiovascular hospitalization/death for heart failure (P_interaction =.46).

There was no statistically significant difference in treatment effect on MACE risk in 5 trials reporting on GLP-1RAs between Hispanic (HR, 0.82; 95% CI, 0.70-0.96) vs non-Hispanic (HR, 0.92; 95% CI, 0.84-1.00; P_interaction =.22) groups. There was a significant difference in treatment effect on MACE risk in 3 trials reporting on DPP-4 inhibitor use between Hispanic (HR, 1.15; 95% CI, 0.98-1.35) vs non-Hispanic (HR, 0.96; 95% CI, 0.88-1.04; P_interaction =.045) groups. There was no statistical heterogeneity between trials (P >.05).

Limitations of the study include the limited number of included trials preventing testing the difference between ethnic groups in meta-regression analysis, as well as lack of randomization in results extracted from stratification analysis. There is also lack of generalizability due to trial inclusion of participants with established or at high risk for cardiovascular disease, and participants with chronic kidney disease.

“Compared with non-Hispanic individuals, Hispanic individuals with T2D appeared to obtain a greater benefit of lowered MACE risk with sodium-glucose cotransporter 2 inhibitors,” the investigators wrote. “We observed no statistically significant difference in treatment effect on MACE risk with GLP-1RAs between Hispanic and non-Hispanic groups.”

Reference

Tang H, Chen W, Bian J, et al. Ethnic variations in cardiovascular and renal outcomes from newer glucose-lowering drugs: a meta-analysis of randomized outcome trials. J Am Heart Assoc. Published online May 9, 2023. doi:10.1161/JAHA.122.026791

This article originally appeared on The Cardiology Advisor