By Colin Kenny, Editor – Diabetes Distilled
Researchers assessed the effect of the glucagon-like peptide-1 receptor agonist dulaglutide on major adverse cardiovascular events in people aged 50 or older with type 2 diabetes and a history of a cardiovascular event or who had cardiovascular risk factors. Participants were randomly assigned (1:1) to receive a weekly subcutaneous injection of dulaglutide 1.5 mg or placebo. They were followed for a median of 5.4 years, during which the first incidence of stroke or myocardial infarction or death from cardiovascular causes was recorded. Dulaglutide reduced the risk of cardiovascular outcomes compared with placebo. Across the three components of the composite primary outcome, the greatest between-group difference was seen in the number of non-fatal strokes.
The Researching Cardiovascular Events with a Weekly Incretin in Diabetes (REWIND) trial was designed to assess whether the addition of dulaglutide to the diabetes medication regimen of middle-aged and older people with type 2 diabetes safely reduced the incidence of cardiovascular outcomes compared with placebo. A total of 9,901 people were recruited and followed up for a median period of 5.4 years. Participants had a mean HbA1c of 56.3 mmol/mol (7.3%), 46.3% were female and almost a third (31.5%) had previous cardiovascular disease on enrolment.
The primary composite outcome occurred in 12% of patients in the dulaglutide arm and 13.4% of patients in the placebo arm. The addition of dulaglutide had no effect on non-fatal myocardial infarction and a neutral effect on cardiovascular death. A 24% reduction in stroke was observed in the dulaglutide arm. There were no between-group differences in all-cause mortality.
Dulaglutide decreases major cardiovascular events in patients with and without atherosclerotic cardiovascular disease. Its use could therefore be considered diabetes patients aged over 50 who have either previous cardiovascular disease or cardiovascular risk factors to reduce the risk of stroke.
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