SGLT2s, GLP-1s benefit both sexes despite greater CV risks among women with diabetes
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The increased risks for cardiovascular disease conferred by diabetes are greater for women than for men, but the newer diabetes drug classes reduce those risks similarly for both sexes, according to a speaker.
“Women with diabetes are at very high risk for CVD, and the CVD risk reduction agents, especially the newer ones, like SGLT2 inhibitors and GLP-1 receptor agonists, are equally efficacious in women and men, so they really should be used in both patient groups,” Neha J. Pagidipati, MD, MPH, assistant professor of medicine and director of the Duke Cardiometabolic Prevention Program, said during an online presentation at the virtual Heart in Diabetes conference.
Diabetes approximately doubled the risks for coronary heart disease and ischemic stroke in the Emerging Risk Factors Collaboration meta-analysis of studies that included 698,782 participants in 102 prospective studies. However, when data were analyzed by sex, diabetes increased risks more for women (HR = 2.59; 95% CI, 2.29-2.93 for CHD; and HR = 2.83; 85% CI, 2.35-3.40 for stroke) than for men (HR = 1.89; 95% CI, 1.73-2.06 for CHD; P ˂ .0001 vs. women; and HR = 2.16; 95% CI, 1.84-2.52 for stroke; P = .0089 vs. women).
Diabetes more than doubled the risk for heart failure for men (RR = 2.36) in the Framingham Heart Study but increased the risk fivefold for women (RR = 5.14). Data from the Swedish National Diabetes Registry showed similar increased risks for heart failure with diabetes by sex for adults younger than 55 years.
Additionally, women enrolled in cardiovascular outcomes trials of diabetes agents were sicker than men who participated, Pagidipati said. Women were more likely than men to enter the trials with heart failure, stroke and chronic kidney disease at baseline. Women also had higher systolic blood pressure, higher LDL cholesterol levels and higher HbA1c, but were less likely to be treated with statins, beta blockers or aspirin therapy.
Despite higher disease burden among women, the diabetes agents with cardiovascular benefits reduced risks equally for women and men across outcomes.
“What I'd like folks to leave with is the idea that women with type 2 diabetes are at particularly high risk for developing cardiovascular disease, and especially young women below the age of 55 [years],” Pagidipati said. “We do have effective therapies for both men and women, specifically the newer agents, SGLT2 inhibitors and GLP-1 receptor agonists, and so these agents should be used in both men and women.”
References:
- Emerging Risk Factors Collaboration. Lancet. 2010;doi:10.1016/S0140-6736(10)60484-9.
- Kannel WB, et al. Am J Cardiol. 1974;doi:10.1016/0002-9149(74)90089-7.
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Pagidipati NJ. Sex differences across type 2 diabetes cardiovascular outcomes trials. Presented at: Heart in Diabetes CME Conference; Aug. 21- 24, 2020, 2019; (virtual meeting).
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