Glucose lowering drugs with proven cardiovascular benefit following acute coronary syndrome in type 2 diabetes: treatment gaps and outcomes

Abstract Background and Aims Real-world data on the implementation and prognostic impact of glucose-lowering drugs with proven cardiovascular benefits in patients with type 2 diabetes (T2D) following acute coronary syndromes (ACS) is limited. We investigated the utilization and treatment patterns of sodium-glucose contrasporter-2 inhibitors (SGLT2I) and glucagon-like peptide-1 receptor-agonists (GLP1RA) in T2D patients experiencing ACS, and analyzed their association with mortality and major adverse cardiovascular events (MACE) including recurrent ACS, acute revascularization, heart failure or ischemic stroke. Methods Retrospective analysis of 9,756 patients with T2D from a nationwide healthcare organization hospitalized with ACS between 01/2019 and 01/2022. Drug prescriptions were estimated pre-hospitalization, 90-days and 1-year following hospitalization. The association between SGLT2I and/or GLP1RA treatment with MACE and mortality was investigated using time-dependent Cox regression analysis with multivariable adjustment. Results Prescription rates (prehospitalization, 90-days and 1-year posthospitalization) of GLP1RA were 13%, 13.2%, and 18%, and of SGLT2I were 23.9%, 33.6% and 42.7%, respectively. At 1-year, 13.9% prescribed both therapeutic groups. The use of SGLT2I and/or GLP1RA was higher in younger age-groups, and increased from 2019 to 2021 (38.1% to 59.2%). The adjusted hazard ratio for the association of pre- or post-hospitalization SGLT2I and/or GLP1RA treatment with mortality and MACE was 0.724 (0.654-0.801) and 0.974 (0.909-1.043), respectively. Conclusions In real-world practice of patients with T2D experiencing ACS, implementation of SGLT2I and particularly GLP1RA was suboptimal, both early and 1-year following hospitalization, emphasizing the need to improve medical care. Treatment with SGLT2I and/or GLP1RA was associated with favorable impact on mortality but not MACE.Graphical Abstract