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Liraglutide Lowers Risk of Cardiovascular Events In Type 2 Diabetes

Dec 8, 2018
 
Editor: Steve Freed, R.PH., CDE

Author: Angela Reyes, Pharm.D. Candidate, LECOM College of Pharmacy

GLP-1 treatment benefits patients on statins and with varying LDL levels.

Low-density lipoprotein cholesterol (LDL) is negatively linked to cardiovascular events. People with type 2 diabetes especially have increased risk of atherosclerotic damage and it is highly recommended these patients take statins to lower LDL levels. Suggested target LDL levels in people with type 2 are below 100 mg/dL for high-risk patients, less than 70 mg/dL for very high-risk patients, and less than 55 mg/dL for patients at extreme risk. Liraglutide is a GLP-1 agonist antidiabetes medication that has shown to help with weight loss. The focus of a new study was to see if it had cardiovascular benefits as well.

A randomized trial called Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results (LEADER) was conducted to research if liraglutide has any cardiovascular benefit in patients with type 2 diabetes. The study enrolled 9,340 people who have type 2 and high cardiovascular risk and randomized them into two groups. One group received 1.8 mg or more of liraglutide while the other group received a placebo. Median follow-up was 3.8 years. Primary outcomes were cardiovascular death, nonfatal myocardial infarction, or nonfatal stoke. At baseline, 926 patients had LDL levels <50 mg/dL, 2021 had 50-70 mg/dL, and 6,240 patients had >70 mg/dL. Also at baseline, 72% of participants were on a statin with an additional 10% adding a statin during treatment.

Results of this study showed higher baseline LDL did correlate to more risk of cardiovascular events as predicted. There were 11.7% in the <50mg/dL group who experienced an event, while 14.2% in >70mg/dL had an event. Among all three groups, those taking liraglutide had reduced risk of a cardiovascular event. In a sensitivity analysis, patients with LDL-C divided at baseline above and below the median of 84.2 mg/dL, liraglutide reduced cardiovascular events in both groups (hazard ratio, 0.88 [95% CI, 0.76–1.03] and 0.86 [95% CI, 0.73–1.01], respectively. The hazard ratio for liraglutide versus placebo for CV events was 0.83 (95% CI, 0.73–0.95) in statin users and 0.97 (95% CI, 0.79–1.20) in nonusers.

These findings suggest liraglutide is beneficial on cardiovascular outcomes and mortality in people with type 2 diabetes who have a high cardiovascular risk. The benefits were seen in patients no matter what their LDL levels were and even if they were using statins. Liraglutide, a GLP-1 agonist, helped to lower lipid levels and reduce cardiovascular risk. With these CV benefits along with weight reduction, GLP-1 agonists are a good option for people who have type 2 diabetes and cardiovascular risks.

Practice Pearls

  • Liraglutide is a GLP-1 agonist that has shown to help with weight loss and new research now shows it is beneficial on cardiovascular health as well.
  • No matter what a patient’s LDL level is, liraglutide reduced risk of cardiovascular events.
  • Liraglutide cam be used alongside statins to achieve optimal risk reduction.

References:

Subodh Verma, Lawrence A. Leiter, C. David Mazer, Stephen C. Bain, John Buse, Steve Marso, Michael Nauck, Bernard Zinman, Heidrun Bosch-Traberg, Soren Rasmussen, Marie M. Michelsen, Deepak L. Bhatt. Liraglutide Reduces Cardiovascular Events and Mortality in Type 2 Diabetes Mellitus Independently of Baseline Low-Density Lipoprotein Cholesterol Levels and Statin Use. Circulation (2018);138:00–00. DOI: 10.1161/CIRCULATIONAHA.118.036862

Angela Reyes, Pharm.D. Candidate, LECOM College of Pharmacy