Risk of Cardiovascular Disease Events in Patients with Type 2 Diabetes Prescribed the GLP-1 Receptor Agonist Exenatide Twice Daily or Other Glucose-Lowering Therapies: A Retrospective Analysis of the LifeLink™ Database
- Jennie H Best, PhD ()1,
- Byron J Hoogwerf, MD2,
- William H Herman, MD, MPH3,
- Elise M Pelletier, MS4,
- Daniel B Smith, MA4,
- Made Wenten, PhD1 and
- Mohamed A Hussein, PhD5
Objective- To test the hypothesis that exenatide twice daily reduces the relative incidence of cardiovascular disease (CVD) events among patients with type 2 diabetes compared to other glucose-lowering agent(s).
Research Design and Methods. Retrospective database analysis of the LifeLink™ database of medical and pharmaceutical insurance claims for June, 2005 through March, 2009. Patients with no history in the preceding 9 months of myocardial infarction, ischemic stroke, or coronary revascularization procedure were assigned to the exenatide-initiated or non-exenatide-initiated cohorts based on the first new prescription filled and reassigned if exenatide was prescribed or discontinued. Incident CVD events (myocardial infarction, ischemic stroke, or coronary revascularization procedure) were identified by ICD-9-CM diagnosis codes. Patient outcomes were adjusted for differences in clinical and demographic characteristics and compared using propensity-score-weighted discrete time survival analysis with time-varying exposure to exenatide.
Results. 39,275 patients with type 2 diabetes were treated with exenatide twice daily and 381,218 patients were treated with other glucose-lowering therapies. Patients who initiated exenatide were more likely to have prior ischemic heart disease, obesity, hyperlipidemia, hypertension and/or other comorbidities at baseline. Exenatide-treated patients were less likely to have a CVD event than non-exenatide-treated patients (hazard ratio, 0.81 [95% confidence interval [CI], 0.68-0.95; P = 0.01]) and lower rates of CVD-related hospitalization (hazard ratio, 0.88 [CI, 0.79-0.98; P = 0.02]) and all-cause hospitalization (hazard ratio, 0.94 [CI, 0.91-0.97; P < 0.001]).
Conclusions Exenatide twice daily treatment was associated with a lower risk of CVD events and hospitalizations than treatment with other glucose-lowering therapies.
- Received July 19, 2010.
- Accepted September 28, 2010.
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