Assessment of cardiovascular event reduction with SGLT2 inhibitors compared to GLP-1 receptor agonists in type 2

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Vijaya Krishna Prasad Vudathaneni1, Swetha Bharathi Nadella1, Kalikrishna Varaprasad Movva2

  • 1Department of Internal Medicine, Columbus Regional Hospital, 2400 17thSt, Columbus, Indiana, United States of America.

Bioinformation
|December 30, 2025
PubMed

Insights

Sodium-glucose co-transporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA) both protect patients with type 2 diabetes mellitus (T2DM) from cardiovascular disease. SGLT2i showed a trend toward reducing major adverse cardiovascular events and significantly lowered heart failure hospitalizations.

Area of Science:

  • Cardiology
  • Endocrinology
  • Pharmacology

Background:

  • Cardiovascular disease (CVD) is the primary cause of death in type 2 diabetes mellitus (T2DM).
  • Sodium-glucose co-transporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA) are antidiabetic agents with proven cardiovascular benefits.
  • Direct comparative data on the cardiovascular outcomes of SGLT2i versus GLP-1 RA in T2DM patients are limited.

Purpose of the Study:

  • To compare the cardiovascular efficacy of SGLT2 inhibitors versus GLP-1 receptor agonists in patients with type 2 diabetes mellitus.
  • To evaluate the incidence of major adverse cardiovascular events (MACE) and hospitalizations for heart failure between the two drug classes.

Main Methods:

  • A retrospective cohort study involving 300 T2DM patients treated between January 2021 and December 2023.
  • Patients were divided into two groups: 150 treated with SGLT2i (empagliflozin or dapagliflozin) and 150 treated with GLP-1 RA (liraglutide or semaglutide).
  • Major adverse cardiovascular events (MACE) and heart failure hospitalizations were tracked over a 24-month period.

Main Results:

  • The SGLT2i group exhibited a lower incidence of MACE (11.3%) compared to the GLP-1 RA group (15.3%), although this difference was not statistically significant (p=0.182).
  • Kaplan-Meier analysis suggested slightly better event-free survival in the SGLT2i group.
  • Hospitalization for heart failure was significantly lower in the SGLT2i group (6.0%) compared to the GLP-1 RA group (10.6%) (p=0.048).
  • Glycemic control, measured by HbA1c reduction, was comparable between both groups (1.2% vs. 1.3%, p=0.456).

Conclusions:

  • Both SGLT2 inhibitors and GLP-1 receptor agonists provide cardiovascular protection in T2DM patients.
  • SGLT2 inhibitors demonstrated a potential advantage in reducing MACE and a significant benefit in decreasing heart failure hospitalizations.
  • Further prospective studies are warranted to confirm these findings and elucidate the comparative cardiovascular benefits.
Keywords:
GLP-1 receptor agonistsMACESGLT2 inhibitorsType 2 diabetes mellituscardiovascular eventsheart failure

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