Dr. Jennie H. Best, with Amylin Pharmaceuticals, Inc. in San Diego, California, and colleagues hypothesized that improved glycemic control, lower blood pressure and lipid levels, and reduced body weight seen with exenatide treatment would reduce the risk of CVD events and hospitalizations compared to other treatments for type 2 diabetes.
To investigate, they analyzed database information on 39,275 patients with type 2 diabetes who were treated with exenatide twice daily and 381,218 patients who received other glucose-lowering therapies, in relation to incident MI, stroke, or coronary revascularization over a 4-year period.
“In the primary analysis, exenatide treated patients were significantly less likely to have a CVD event (HR 0.81; p=0.01) compared to nonexenatide- treated patients,” according to the report.
Exenatide-treated patients had higher rates of prior ischemic heart disease, obesity, hyperlipidemia, hypertension and other comorbidities. A propensity score based on more than 300 variables was generated for each patient and used to adjust for potential selection bias in the final analyses.
The final propensity score-stratified analysis hardly differed from the primary analysis: the HR for a CVD event in exenatide-treated patients was 0.80 (p<0.001) compared to non-exenatide-treated patients.
“Consistent with the reduced frequency of CVD events, exenatide initiators had lower rates of hospitalization for CVD-related events (HR 0.88; p=0.02) during the follow-up period compared to the non-initiators, and a lower rate of all-cause hospitalization (HR 0.94; p<0.001),” Dr. Best and colleagues report.
They conclude that prospective studies of exenatide are now needed to confirm the improved cardiovascular outcomes observed in this retrospective database analysis.
Risk of Cardiovascular Disease Events in Patients with Type 2 Diabetes Prescribed the GLP-1 Receptor Agonist Exenatide Twice Daily or Other Glucose-Lowering Therapies: A Retrospective Analysis of the LifeLink™ Database
Diabetes Care 2010.