GLP1 receptor agonists are a class of medication for type 2 diabetes that reduce blood sugar and weight. While several GLP1 receptor agonists (including liraglutide, semaglutide, and albiglutide) have been shown to decrease the risk of cardiovascular events in people with type 2 diabetes and established cardiovascular disease, we haven’t had much data in people with type 2 diabetes without a prior history of cardiovascular disease – until now.
The REWIND study, published last week in The Lancet, evaluated the effect of dulaglutide (Trulicity) on cardiovascular events in people with type 2 diabetes. The study enrolled 9,901 people from 24 countries; 68.5% of these people had no prior history of cardiovascular disease. The primary endpoint was the standard composite endpoint of cardiovascular death, heart attack, or stroke.
After a median of 5.4 years, dulaglutide significantly reduced the risk of cardiovascular events by 12%. This reduction in cardiovascular risk was driven by a significant 24% reduction in risk of stroke. Dulaglutide did not have a significant impact on death rates.
The cardiovascular benefit was enjoyed by people with and without a prior history of cardiovascular disease. For every 60 people with type 2 diabetes and no history of cardiovascular disease treated for 5.4 years, one cardiovascular event is prevented. For people with a prior cardiovascular event, the number needed to treat is 18.
The REWIND trial represents yet another paradigm shift in the rapidly evolving field of type 2 diabetes, in that we now have evidence for cardiovascular protection with a GLP1 receptor agonist in people without a prior history of cardiovascular disease.
It is wonderful to see a broadening of the patient population that can enjoy cardiovascular benefits of the newer classes of diabetes medications.
Disclaimer: I was involved as an investigator in the REWIND trial. I receive honoraria as a continuing medical education speaker and consultant from the makers of dulaglutide (Eli Lilly).
Dr Sue Pedersen www.drsue.ca © 2019
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