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Cardiovascular Outcomes in GRADE (Glycemia Reduction Approaches in Type 2 Diabetes: A Liraglutide Comparative Effectiveness Study)

Authoring team

This study investigated cardiovascular outcomes by treatment group in participants randomly assigned to insulin glargine, glimepiride, liraglutide, or sitagliptin, added to baseline metformin, in GRADE (Glycemia Reduction Approaches in Type 2 Diabetes: A Comparative Effectiveness Study):

  • total of 5047 participants with a mean±SD age of 57.2±10.0 years, type 2 diabetes duration of 4.0±2.7 years, and low baseline prevalence of cardiovascular disease (myocardial infarction, 5.1%; cerebrovascular accident, 2.0%) were followed for a median of 5 years
  • prespecified outcomes included between-group time-to-first event analyses of
    • MACE-3 (composite of major adverse cardiovascular events: cardiovascular death, myocardial infarction, and stroke),
    • MACE-4 (MACE-3+unstable angina requiring hospitalization or revascularization),
    • MACE-5 (MACE-4+coronary revascularization),
    • MACE-6 (MACE-5+hospitalization for heart failure), and the individual components
  • MACE outcomes and hospitalization for heart failure in the liraglutide-treated group were compared with the other groups

  • found no significant differences in cumulative incidence of first MACE-3, MACE-4, MACE-5, or MACE-6, or individual components, by treatment group, but liraglutide group had lower risk of MACE-5, MACE-6 and heart failure hospitalisation vs other groups combined

  • study authors concluded:
    • comparative effectiveness study of a contemporary cohort of adults with type 2 diabetes, largely without established cardiovascular disease, suggests that liraglutide treatment may reduce the risk of cardiovascular events in patients at relatively low risk compared with other commonly used glucose-lowering medications

Reference:

  • Green JB et al. Cardiovascular Outcomes in GRADE (Glycemia Reduction Approaches in Type 2 Diabetes: A Comparative Effectiveness Study). Circulation February 12th 2024

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