Early impact of liraglutide in routine clinical use (ABCD nationwide liraglutide audit) on cardiovascular risk (UKPDS risk engine)
Keywords:liraglutide, cardiovascular risk, ABCD ationwide audit, UKPDS risk engine, numbers needed to treat
Aims: Liraglutide has been shown to reduce cardiovascular mortality in a cardiovascular safety study, but it is not known to what extent these results will be replicated in real practice with people with diabetes treated with liraglutide in the UK. We wished to explore the likely cardiovascular benefits by modelling 10-year reduction in cardiovascular events and mortality using data from the ABCD liraglutide audit database.
Methods: The UKPDS risk engine 2.0 was applied to data collected in the ABCD liraglutide audit database before and at the earliest return to clinic between 3 and 9 months after commencing liraglutide, using the 747 of 6,959 records where all factors used by the risk engine were completely recorded.
Results: There were significant falls in all factors used in the UKPDS cardiovascular disease (CVD) risk assessment other than HDL cholesterol which was unchanged. The UKPDS risk engine mean±SD 10-year coronary heart disease (CHD) risk fell by 2.7±7.6% from 18.7±13.0% to 16.1±11.6% (p<0.001). The 10-year fatal CHD risk fell by 2.3±6.5% from 13.7±11.1% to 11.4±9.8% (p<0.001). The 10-year stroke risk fell by 0.3±2.8% from 7.9±8.7% to 7.6±8.3% (p=0.003). The 10-year fatal stroke risk fell by 0.1±0.7% from 1.2±1.4% to 1.1±1.3% (p=0.001).
Conclusion: Starting liraglutide reduced 10-year CVD risk. These data suggest that liraglutide used in routine clinical care in 100 patients could prevent three events of CHD or stroke and save two or more lives over the next 10 years.
Marso SP, Daniels GH, Brown-Frandsen K, et al, for the LEADER Steering Committee on behalf of the LEADER Trial Investigators. N Engl J Med 2016;375:311–22. https://doi.org/10.1056/NEJMoa1603827
UKPDS CVD Risk Engine 2.0. https://www.dtu.ox.ac.uk/riskengine/
Marso SP, Poulter NR, Nissen SE, et al. Design of the liraglutide effect and action in diabetes: evaluation of cardiovascular outcome results (LEADER®) trial. Am Heart J 2013;166:823–30. https://doi.org/10.1016/j.ahj.2013.07.012
Smeeth L, Haines A, Ebrahim S. Numbers needed to treat derived from meta-analyses--sometimes informative, usually misleading. BMJ 1999; 318:1548–51. https://doi.org/10.1136/bmj.318.7197.1548
Jousilahti P, Tuomilehto J, Vartiainen E, Pekkanen J, Pushka P. Body weight, cardiovascular risk factors, and coronary mortality: 15-year follow-up of middle-aged men and women in eastern Finland. Circulation 1996;93:1372–9. https://doi.org/10.1161/01.CIR.93.7.137
Miller MT, Lavie CJ, White CJ. Impact of obesity on the pathogenesis and prognosis of coronary heart disease. J Cardiometab Syndr 2008;3:162–7. https://doi.org/10.1111/j.1559-4572.2008.00004.x
Zhao X, Huang K, Zheng M, Duan J .Effect of liraglutide on blood pressure: a meta-analysis of liraglutide randomized controlled trials. BMC Endocrine Disorders 2019;19:4. https://doi.org/10.1186/s12902-018-0332-5
Sun F, Wu S, Wang J, et al. Effect of glucagon-like peptide-1 receptor agonists on lipid profiles among type 2 diabetes: a systematic review and network meta-analysis. Clin Ther 2015;37:225–41.e8 https://doi.org/10.1016/j.clinthera.2014.11.008
Matikainen N, Söderlund S, Björnson E, et al. Liraglutide treatment improves postprandial lipid metabolism and cardiometabolic risk factors in humans with adequately controlled type 2 diabetes: a single-centre randomized controlled study. Diabetes Obes Metab 2019;21:84–94. https://doi.org/10.1111/dom.13487
Rondanelli M, Perna S, Astrone P, Grugnetti A, Solerte S, Guido D. Twenty-four-week effects of liraglutide on body composition, adherence to appetite, and lipid profile in overweight and obese patients with type 2 diabetes mellitus. Patient Prefer Adherence 2016;10:407–13. https://doi.org/10.2147/PPA.S97383 PMCID: PMC48180
Marre M, Shaw J, Brandle M, et al. Liraglutide, a once-daily human GLP-1 analogue, added to a sulphonylurea over 26 weeks produces greater improvements in glycaemic and weight control compared with adding rosiglitazone or placebo in subjects with type 2 diabetes (LEAD-1 SU). Diabet Med 2009;26:268–78. https://doi.org/10.1111/j.1464-5491. 2009.02666.x
Nauck M, Frid A, Hermansen K, et al. Efficacy and safety comparison of liraglutide, glimepiride, and placebo, all in combination with metformin, in type 2 diabetes: the LEAD (liraglutide effect and action in diabetes)-2 study. Diabetes Care 2009;32:84–90. https://doi.org/10.2337/dc08-1355
Garber A, Henry R, Ratner R, et al. Liraglutide versus glimepiride monotherapy for type 2 diabetes (LEAD-3 Mono): a randomised, 52-week, phase III, double-blind, parallel-treatment trial. Lancet 2009; 373:473–81. https://doi.org/10.1016/S0140-6736(08)61246-5
Zinman B, Gerich J, Buse JB, et al. Efficacy and safety of the human glucagon-like peptide-1 analog liraglutide in combination with metformin and thiazolidinedione in patients with type 2 diabetes (LEAD-4 Met+TZD). Diabetes Care 2009;32:1224–30. https://doi.org/10.2337/dc08-2124
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