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Cardiovascular outcomes of GLP-1RA vs SGLT2i in MASLD and type 2 diabetes: real-world evidence

Chun-Chi Yang1, Jheng-Yan Wu2, Ya-Yun Cheng3

  • 1Division of Hepatogastroenterology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan; School of Medicine and Doctoral Program of Clinical and Experimental Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan.

Diabetes Research and Clinical Practice
|March 9, 2026
PubMed
Abstract

Insights

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) show greater cardiovascular protection than sodium-glucose cotransporter-2 inhibitors (SGLT2is) in patients with metabolic dysfunction-associated steatotic liver disease and type 2 diabetes. This real-world study provides evidence for reduced cardiovascular events with GLP-1 RAs.

Area of Science:

  • Cardiology
  • Endocrinology
  • Hepatology

Background:

  • Patients with metabolic dysfunction-associated steatotic liver disease (MASLD) and type 2 diabetes (T2D) face elevated cardiovascular risk.
  • The comparative cardiovascular protective effects of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) versus sodium-glucose cotransporter-2 inhibitors (SGLT2is) in this population are not well-established.

Purpose of the Study:

  • To compare the cardiovascular outcomes of GLP-1 RAs versus SGLT2is in patients with MASLD and T2D.
  • To provide real-world evidence on the comparative effectiveness of these drug classes for cardiovascular risk reduction.

Main Methods:

  • A retrospective cohort study utilizing the TriNetX global health research network.
  • Propensity score matching was employed to balance patient characteristics, comorbidities, and medications.
  • Outcomes were analyzed using Cox proportional-hazards models and target-trial emulation principles.

Main Results:

  • The study included 52,094 patients with MASLD and T2D, followed for a median of 3.0 years.
  • GLP-1 RA use was associated with a significantly lower risk of major adverse cardiovascular and cerebrovascular events compared to SGLT2is (HR 0.86, 95% CI 0.80-0.92).
  • Reduced risks of heart failure, myocardial infarction, stroke, and all-cause mortality were observed with GLP-1 RAs.

Conclusions:

  • GLP-1 RA therapy demonstrated superior cardiovascular protection compared to SGLT2is in patients with MASLD and T2D.
  • This study offers valuable real-world comparative evidence supporting the use of GLP-1 RAs for cardiovascular risk management in this high-risk group.
Keywords:
Cardiovascular outcomesGLP-1RAsMASLDReal-world evidenceSGLT2isType 2 diabetes

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