Assessment of cardiovascular event reduction with SGLT2 inhibitors compared to GLP-1 receptor agonists in type 2 diabetes mellitus

Abstract

Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality in individuals with type 2 diabetes mellitus (T2DM). Antidiabetic agents, sodium-glucose co-transporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA) have demonstrated cardiovascular benefits, though direct comparative data are limited. This retrospective cohort study analysed records of 300 T2DM patients treated between January 2021 and December 2023 at a tertiary care centre. Patients were divided into two groups: Group A (n=150) received SGLT2i (empagliflozin or dapagliflozin), and Group B (n=150) received GLP-1 RA (liraglutide or semaglutide). Major adverse cardiovascular events (MACE), including myocardial infarction, stroke, and cardiovascular death, were tracked over 24 months. Group A showed a lower incidence of MACE (11.3%) compared to Group B (15.3%), though the difference was not statistically significant (p=0.182). Kaplan-Meier curves indicated slightly better event-free survival in the SGLT2i group. Haemoglobin A1c reduction was similar between the groups (1.2% vs. 1.3%, p=0.456), while hospitalization for heart failure was significantly lower in the SGLT2i group (6.0% vs. 10.6%, p=0.048). Thus, we show that both SGLT2 inhibitors and GLP-1 receptor agonists offer cardiovascular protection in T2DM, with SGLT2i providing a modest advantage in reducing MACE and a significant benefit in lowering heart failure hospitalizations.