An Australian population-based study conducted by Monash University has compared two classes of type two diabetes drugs and found that one is associated with a greater reduction of major adverse cardiovascular events in men than women.
The study compared SGLT2 inhibitors (SGLT2i) and GLP-1 receptor agonists (GLP-1RA). Both classes reduce major adverse cardiovascular events in people with type two diabetes.
Women with type two diabetes have a greater risk of developing cardiovascular disease and heart failure than men. Despite this, the treatment approaches for diabetes-induced cardiovascular disease are the same.
The study, published in The Lancet Regional Health – Western Pacific, included 8026 men and women under 30, discharged from a Victorian hospital between 1st July 2013 and 1st July 2017, and dispensed an SGLT2i or GLP-1RA within 60 days of discharge.
The study found that men dispensed SGLT2i had a 22 per cent reduction rate in major adverse cardiovascular events compared to men who supplied a GLP-1RA. In women, there was no significant difference between SGLT2i and GLP-1RAs for their effects on major adverse cardiovascular events.
The study’s first author and MIPS PhD candidate, Abhipree Sharma, said the apparent disparity between the relative benefits of SGLT2i versus GLP-1RAs in type two diabetes men and women warrants further investigation.
“Treatment recommendations for type two diabetes-associated cardiovascular disease and heart failure remain the same in men and women despite known sex differences in the development and presentation of these diseases.”
“Our analyses suggest that these newer classes of glucose-lowering therapies can, in fact, exert more favourable effects depending on age and sex, which is something we believe needs to be explored further,” said Ms Sharma.
Leader of Heart Failure Pharmacology at MIPS and corresponding senior author, Professor Rebecca Ritchie, said there may be a number of reasons women with type two diabetes are more at risk of developing cardiovascular disease and heart failure than men with type two diabetes.
“Typically, women with type two diabetes present with greater insulin resistance, endothelial dysfunction, inflammation, abdominal adiposity, body mass index, and blood glucose and cholesterol levels than men with type two diabetes. Additionally, increases in cardiovascular disease and heart failure risk in postmenopausal women suggests an integral role for estrogen in cardioprotection in women.”
“Our hope is that the findings from this large population-based study will lead to a deeper dive into the most effective pharmacological treatment recommendations based on factors including sex, age and heart failure history,” Professor Ritchie concluded.
