Cardiovascular risk and lifetime benefit from preventative treatment in type 2 diabetes

The aim of this post hoc analysis of the CAPTURE study, a non-interventional, cross-sectional study collecting demographic and clinical characteristics of 9823 adults with type 2 diabetes from 13 countries, was to estimate the potential benefits, in terms of time free from a first or recurrent cardiovascular event, of optimising cardiovascular risk management (achieving targets for LDL-cholesterol, HbA_1c and systolic blood pressure, as well as aspirin for secondary prevention, and smoking cessation) and initiating either a GLP-1 receptor agonist or an SGLT2 inhibitor.

Data on 9416 individuals were analysed. The DIAL model was used to estimate lifetime cardiovascular risk and treatment benefit. Hazard ratios from meta-analyses were used to estimate treatment benefits of GLP-1 RAs and SGLT2 inhibitors.

Within the CAPTURE cohort, a wide distribution of predicted cardiovascular risk in people with and without a history of CVD was observed. Use of antihypertensives, statins and aspirin was much more common in patients with CVD; however, no clear difference in GLP-1 RA and SGLT-2i use was seen between patients with and without CVD.

The mean lifetime benefit from optimal cardiovascular risk management was 3.9±3.0 years in people with established cardiovascular disease (CVD), and 1.3±1.9 years in those without CVD. Further addition of a GLP-1 RA or SGLT2 inhibitor in people with established CVD added a mean lifetime benefit of 1.2±0.6 years. Higher lifetime benefits of preventative treatment were seen in those with a higher predicted CVD risk, and in younger patients.

The authors conclude that the number of life-years free of (recurrent) CVD gained by optimal cardiovascular risk management and the addition of a GLP-1 RA or SGLT2 inhibitor is dependent on baseline CVD status. These results aid individualising prevention and promote shared decision-making with people living with type 2 diabetes.

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