Incretin Mimetics and Cardiovascular Events—The Evolving Comparative Effectiveness Landscape

Adverse cardiovascular events are by far the leading cause of premature mortality for adults with type 2 diabetes, and postmarketing randomized cardiovascular (CV) outcome trials of newly marketed glucose-lowering medications, as mandated by the US Food and Drug Administration, have demonstrated that compared with placebo, many incretin mimetics (including glucagon-like peptide-1 receptor agonists [GLP-1RA] and the glucose-dependent insulinotropic polypeptide/ GLP-1RA tirzepatide) confer substantial cardiovascular benefits in adults with type 2 diabetes and high CV risk.Incretin mimetics have revolutionized diabetes care and are used by a steadily increasing proportion of patients with diabetes.Clinicians often must decide which among many available incretin mimetics is best for a given adult with diabetes.American Diabetes Association guidelines support the use of incretin mimetics in patients with diabetes and atherosclerotic cardiovascular disease or high CV risk but do not indicate which incretin mimetic may be best for a particular patient.Because CV outcome trials vary in patient eligibility and outcome criteria, it is difficult to use these data to directly compare the CV benefits of specific GLP-1RA agents.In this study, Derington et al 1 provide new information on the comparative effectiveness of 3 GLP-1RA agents for cardiorenal outcomes and overall mortality in 21 790 veterans with diabetes and a wide range of CV risk who newly initiated treatment with semaglutide, liraglutide, or dulaglutide from January 1, 2018, to December 31, 2021.Results indicate that liraglutide and semaglutide have