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Effect of combination treatment with glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter-2 inhibitors on incidence of cardiovascular and serious renal events: population based cohort study

Objective To determine whether the combined use of glucagon-like peptide-1 (GLP-1) receptor agonists and sodium-glucose cotransporter-2 (SGLT-2) inhibitors is associated with a decreased risk of major adverse cardiovascular events and serious renal events compared with either drug class alone among patients with type 2 diabetes, and to assess the effect of the combination on the individual components of major adverse cardiovascular events, heart failure, and all cause mortality.

Design Population based cohort study using a prevalent new-user design, emulating a trial.

Setting UK Clinical Practice Research Datalink linked to Hospital Episode Statistics Admitted Patient Care and Office for National Statistics databases.

Participants Two prevalent new-user cohorts were assembled between January 2013 and December 2020, with follow-up until the end of March 2021. The first cohort included 6696 patients who started GLP-1 receptor agonists and added on SGLT-2 inhibitors, and the second included 8942 patients who started SGLT-2 inhibitors and added on GLP-1 receptor agonists. Combination users were matched, in a 1:1 ratio, to patients prescribed the same background drug, duration of background drug, and time conditional propensity score.

Main outcome measures Cox proportional hazards models were fitted to estimate the hazard ratios and 95% confidence intervals of major adverse cardiovascular events and serious renal events, separately, comparing the GLP-1 receptor agonist-SGLT-2 inhibitor combination with the background drug, either GLP-1 receptor agonists or SGLT-2 inhibitors, depending on the cohort. Secondary outcomes included associations with the individual components of major adverse cardiovascular events (myocardial infarction, ischaemic stroke, cardiovascular mortality), heart failure, and all cause mortality.

Results Compared with GLP-1 receptor agonists, the SGLT-2 inhibitor-GLP-1 receptor agonist combination was associated with a 30% lower risk of major adverse cardiovascular events (7.0 v 10.3 events per 1000 person years; hazard ratio 0.70, 95% confidence interval 0.49 to 0.99) and a 57% lower risk of serious renal events (2.0 v 4.6 events per 1000 person years; hazard ratio 0.43, 0.23 to 0.80). Compared with SGLT-2 inhibitors, the GLP-1 receptor agonist-SGLT-2 inhibitor combination was associated with a 29% lower risk of major adverse cardiovascular events (7.6 v 10.7 events per 1000 person years; hazard ratio 0.71, 0.52 to 0.98), whereas serious renal events generated a wide confidence interval (1.4 v 2.0 events per 1000 person years; hazard ratio 0.67, 0.32 to 1.41). Secondary outcomes generated similar results but with wider confidence intervals.

Conclusions In this cohort study, the GLP-1 receptor agonist-SGLT-2 inhibitor combination was associated with a lower risk of major adverse cardiovascular events and serious renal events compared with either drug class alone.

This study is based on data from the Clinical Practice Research Datalink obtained under license from the UK Medicines and Healthcare products Regulatory Agency. The data are provided by patients and collected by the UK National Health Service as part of their care and support. The interpretation and conclusions contained in this study are those of the authors alone. Because electronic health records are classified as “sensitive data” by the UK Data Protection Act, information governance restrictions (to protect patient confidentiality) prevent data sharing via public deposition. Data are available with approval, through the individual constituent entities controlling access to the data. Specifically, the primary care data can be requested via application to the Clinical Practice Research Datalink (<https://www.cprd.com>).

United-kingdom , Bristol , City-of , Montreal , Quebec , Canada , Canadian , British , Canadian-institutes-of-health-research , Novartis , Setting-united-kingdom-clinical-practice-research-datalink

Sydney mansions: fate of faded beauties hangs in balance

Some the city’s historically significant and most loved homes of yesteryear have fallen into decay, putting their survival at serious risk.

Paddington , Western-australia , Australia , Bidura , New-south-wales , Narellan , Hollywood , California , United-states , Darling-point , China , Edgecliff

Sydney mansions: fate of faded beauties hangs in balance

Sydney mansions: fate of faded beauties hangs in balance
theage.com.au - get the latest breaking news, showbiz & celebrity photos, sport news & rumours, viral videos and top stories from theage.com.au Daily Mail and Mail on Sunday newspapers.

Hollywood , California , United-states , China , Narellan , New-south-wales , Australia , Edgecliff , Paddington , Western-australia , Darling-point , Leura

'101 Treasures': Travel back in time at the National Library of Israel

Reading 101 Treasures from the National Library of Israel is like wandering through a fascinating museum where each exhibit has something exciting and unusual to teach you

Israel , Baghdad , Iraq , Jerusalem , Israel-general- , Australia , Givat-ram , Yerushalayim , Cairo , Al-qahirah , Egypt , United-states

The Lady with a Golden Heart participated at the Disability Affairs Fun Day….

The Lady with a Golden Heart participated at the Disability Affairs Fun Day….
bahamaspress.com - get the latest breaking news, showbiz & celebrity photos, sport news & rumours, viral videos and top stories from bahamaspress.com Daily Mail and Mail on Sunday newspapers.

Lady-davis , Ann-marie-davis , Olympics , Department-of-social-services , Special-olympics , Disability-affairs-division , Lady-mrs-ann-marie-davis , Christmas-joy , Social-services ,

Office of the Spouse sends Christmas cheer!

Office of the Spouse sends Christmas cheer!
bahamaspress.com - get the latest breaking news, showbiz & celebrity photos, sport news & rumours, viral videos and top stories from bahamaspress.com Daily Mail and Mail on Sunday newspapers.

Nassau , New-providence , Bahamas , The , Lady-davis , Ann-marie-davis , Office-of-the-spouse , Ministry-of-foreign-affairs , Nazareth-centre , Prime-minister , Christmas-giveaway , Foreign-affairs

Jewish General uses self-service platform, synthetic data to democratize analytics

Operational staff are focused on improving efficiency and reducing delays, while clinical teams are looking at quality improvement projects. A thriving research community, meanwhile, is digging deep into data for many different use cases.

Montreal , Quebec , Canada , Justin-cross , Mdclone-adams , Lady-davis-institute , Jewish-general-hospital , Lady-davis , Jewish-general , General-hospital ,

What does Jerusalem's top haredi lawmaker think of the city's struggles?

Eliezer Rauchberger is the second most powerful man in the Jerusalem Municipality. An ultra-Orthodox politician, here is what he thinks about the city and his role in it.

Jerusalem , Israel-general- , Israel , Yeruham , Hadarom , Lithuania , Lithuanian , Israeli , State-of-israel , Fleur-hassan-nahoum , Degel-hatorah , Elisha-peleg

Jerusalem parties feud over haredi schools in secular neighborhoods

What is on the agenda now is feeling among some of the city’s residents that the ultra-Orthodox representatives are establishing facts on the ground and preparing to deepen their influence.

Kiryat-hayovel , Yerushalayim , Israel , Denmark , Jerusalem , Israel-general- , Amal-lady-davis , Safra-square , Hashomer-hatzair , Yossi-havilio , Lady-davis , Adir-schwartz