Semaglutide use adds CVD-free life-years for high-risk adults with type 2 diabetes
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Adults with type 2 diabetes at high risk for cardiovascular disease add 1.7 life-years free of CVD when prescribed semaglutide along with standard diabetes care, according to study findings published in Diabetes Care.
“The addition of semaglutide to standard of care was associated with an important gain in life-years free of new and recurrent CVD events and a decrease in 10-year CVD risk,” Jan Westerink, MD, PhD, internist in the department of vascular medicine at the University Medical Centre Utrecht in the Netherlands, and colleagues wrote. “The distribution of estimated life-years free of new and recurrent CVD events gained with semaglutide was wide, reflecting variation in absolute benefit gained with semaglutide between patients, with those with higher baseline risk and who were younger at treatment initiation experiencing the greatest absolute benefit.”
Researchers collected data from the SUSTAIN 6 and PIONEER 6 randomized, double-blind, placebo-controlled trials, both of which evaluated the effects of semaglutide (Wegovy, Novo Nordisk) in people with type 2 diabetes at high risk for CVD. The data from the two trials were pooled together to calculate a reduced risk for major adverse CV events with the addition of semaglutide to standard of care (HR = 0.76; 95% CI, 0.62-0.92). The Diabetes Lifetime-perspective prediction model was used to calculate life expectancy free of new or recurrent CVD events by using the pooled HR and combining it with a person’s individual risk factors. Life-years free of new and recurrent CVD events were calculated as the difference between baseline age and the age where the estimated cumulative probability of survival-free from major adverse CV events falls below 50%. Ten-year CVD risk was calculated as the sum of yearly risk for major adverse CV events over 10 years from the patients’ current age.
Of the cohort, 72.8% had established CVD, 16.3% had CV risk factors and 10.9% had chronic kidney disease with no prior CVD. The addition of semaglutide to standard of care was associated with a mean increase of 1.7 life-years free of new or recurrent CVD events and a mean absolute reduction in 10-year CVD risk of 6% for the full cohort.
Participants were divided into quartiles based on which patients would benefit the most from the addition of semaglutide. The quartile of participants who would benefit the most had a mean gain of 2.8 life-years free of new and recurrent CVD events, whereas the quartile of adults benefiting the least had a mean gain of 0.4 life-years free of CVD events.
Participants with established CVD had a larger gain in life-years free of CVD events with the addition of semaglutide due to having a higher baseline risk. Adults with CKD had a gain of 1.7 life-years free of new and recurrent CVD events. The mean absolute reduction in 10-year CVD risk was 6.8% for those with established CVD and 8.5% for those with CKD.
The mean number of life-years free of CVD events with semaglutide decreased with increasing age. Adults aged 50 to 54 years gained 2.9 life-years free of CVD events, whereas those aged 85 to 90 years gained 0.6 additional life-years free of CVD events.
“The addition of semaglutide to standard of care in people with type 2 diabetes was associated with a wide distribution in the gain in life-years free of new and recurrent CVD events, with greater absolute benefit seen in younger people and those with established CVD,” the researchers wrote. “This study helps to contextualize the results of CV outcomes trials of use of semaglutide and can be used to aid in clinical decision-making.”
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