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Prescription Patterns of Sodium-Glucose Cotransporter 2 Inhibitors and Glucagon-Like Peptide-1 Receptor Agonists in Patients with Coronary Artery Disease

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Abstract

Purpose

To assess real-world data on the clinical implementation of sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) in cardiovascular patients and to investigate barriers to prescribe these agents.

Methods

Patients presenting with coronary artery disease (CAD) and type 2 diabetes mellitus (T2DM) between 01/2014 and 04/2020 were included in the present analysis and followed prospectively. All first-time prescriptions of SGLT2i and GLP-1RA were identified.

Results

Among 1498 patients with CAD and T2DM, 17.6% of patients received an SGLT2i and 5.5% a GLP-1RA. The prescription of SGLT2i (+38.7%; p < 0.001) and GLP-1RA (+8%; p = 0.007) significantly increased during the observation period. Considering remuneration criteria for SGLT2i therapy, lowering the GFR cut-off to 30 ml/min/1.73 m2 would allow additional 26.6% of patients to qualify for an SGLT2i therapy. While SGLT2i therapy was inversely associated with CV mortality (adjusted hazard ratio of 0.18 [95% CI: 0.05–0.76]; p = 0.019), GLP-1RA therapy showed a trend for risk reduction.

Conclusion

The present analysis revealed an infrequent prescription of SGLT2i and GLP-1RAs in patients with T2DM and CAD in clinical practice. Remuneration regulations that better reflect the inclusion criteria of the CV outcome trials would allow more patients at high risk to receive these CV protective drugs. Most importantly, while GLP-1RA therapy showed a trend for risk reduction of cardiovascular mortality, the use of SGLT2i had a strong inverse impact on cardiovascular mortality from a long-term perspective.

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Data Availability

Data will be provided upon request.

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Authors and Affiliations

  1. Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria

    Felix Hofer, Niema Kazem, Ronny Schweitzer, Andreas Hammer, Friedrich Jakse, Lorenz Koller, Christian Hengstenberg, Patrick Sulzgruber & Alexander Niessner

Authors
  1. Felix Hofer
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  2. Niema Kazem
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  3. Ronny Schweitzer
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  4. Andreas Hammer
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  5. Friedrich Jakse
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  6. Lorenz Koller
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  8. Patrick Sulzgruber
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  9. Alexander Niessner
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Contributions

AN, PS, and FH contributed to the conception or design of the work. FH, AH, RS, and FJ contributed to the acquisition, analysis, or interpretation of data for the work. FH drafted the manuscript. AN, NK, LK, and CH critically revised the manuscript. All gave final approval and agree to be accountable for all aspects of work ensuring integrity and accuracy.

Corresponding author

Correspondence to Patrick Sulzgruber.

Ethics declarations

Ethical Approval

This article does not contain any studies with human participants performed by any of the authors.

Due to the observational character of the study, patient informed consent was not required.

The study protocol complies with the declaration of Helsinki and was approved by the local ethics committee of the Medical University of Vienna (EK 2267/2019).

Conflict of Interest

Felix Hofer: none

Niema Kazem: none

Ronny Schweitzer: none

Andreas Hammer: none

Friedrich Jakse: none

Lorenz Koller: none

Christian Hengstenberg: none

Patrick Sulzgruber: grants from Daiichi Sankyo, grants from AstraZeneca, and grants from Boehringer-Ingelheim outside the submitted work

Alexander Niessner: personal fees from Bayer, personal fees from BMS, grants and personal fees from Boehringer Ingelheim, grants and personal fees from Daiichi Sankyo, and personal fees from Pfizer outside the submitted work

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Hofer, F., Kazem, N., Schweitzer, R. et al. Prescription Patterns of Sodium-Glucose Cotransporter 2 Inhibitors and Glucagon-Like Peptide-1 Receptor Agonists in Patients with Coronary Artery Disease. Cardiovasc Drugs Ther 35, 1161–1170 (2021). https://doi.org/10.1007/s10557-021-07160-8

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  • DOI: https://doi.org/10.1007/s10557-021-07160-8

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