To evaluate the effectiveness and implementation of GLP-1 receptor agonists (GLP-1RAs) in secondary prevention among patients with Type 2 diabetes (T2D) post-myocardial infarction (MI) or ischaemic stroke, highlighting the significance of bridging the gap in real-world evidence.
Key Findings:
Fewer than 2% of MI survivors and ∼0.5% of stroke survivors initiated GLP-1RA therapy within 12 months post-event, indicating a significant gap in treatment adherence.
GLP-1RA use was associated with a ∼30% lower risk of major adverse cardiovascular events (MACEs) and 40–45% lower risks of cardiovascular and all-cause mortality, suggesting potential benefits in high-risk populations.
The observed mortality associations may be overestimated due to unmeasured confounding factors, necessitating cautious interpretation.
Interpretation:
GLP-1RAs may significantly enhance secondary prevention strategies for T2D patients post-MI or stroke, but the observed benefits require cautious interpretation due to potential confounding factors and the need for further research.
Limitations:
Registry-based analysis may not capture critical clinical factors influencing treatment decisions and prognosis, including frailty and comorbidities.
Low uptake of GLP-1RA therapy indicates a gap between clinical guidelines and real-world practice, highlighting the need for improved implementation strategies.
Potential biases due to socioeconomic factors affecting treatment access and outcomes should be acknowledged.
Conclusion:
The findings highlight the need for improved implementation of GLP-1RAs in high-risk T2D populations, alongside addressing barriers to therapy initiation to enhance patient outcomes.
