HEART health in type 2 diabetes has taken centre stage, as a major study reveals that certain glucose-lowering medications significantly reduce cardiovascular risk, with GLP-1 receptor agonists emerging as the most protective option.
Why Heart Health in Type 2 Diabetes Matters
People with type 2 diabetes face a disproportionately high risk of cardiovascular complications, making heart health in type 2 diabetes a critical clinical priority. Major adverse cardiovascular events (MACEs), including heart attack, stroke and cardiovascular death, remain leading causes of morbidity and mortality in this group. With limited head-to-head trials, treatment decisions have often lacked clarity, prompting researchers to compare the heart-protective effects of widely used diabetes medications. Understanding how these drug classes impact cardiovascular outcomes may transform prescribing strategies.
Medication Classes and Cardiovascular Outcomes
In a comparative effectiveness study involving 296 676 adults with type 2 diabetes across six US health systems, researchers evaluated sustained use of four medication classes: sulfonylureas, DPP4 inhibitors (DPP4is), SGLT2 inhibitors (SGLT2is) and GLP-1 receptor agonists (GLP-1RAs). A trial emulation subset of 241 981 adults, with a mean age of 57.2 years and 54.3% male, was analysed using targeted learning methods. The 2.5-year risk of MACEs was lowest among those treated with GLP-1RAs, followed by SGLT2is, sulfonylureas and DPP4is. When comparing drug classes, cumulative risk differences were 1.9% (95% CI, 1.1%-2.7%) for DPP4is versus sulfonylureas and 1.5% (1.1%-1.9%) for SGLT2is versus GLP-1RAs. The cardiovascular benefit of GLP-1RAs was most pronounced in patients aged 65 or above, those with baseline atherosclerotic cardiovascular disease (ASCVD), heart failure or mild to moderate kidney impairment.
Implications for Clinical Practice
The findings provide crucial guidance for improving heart health in type 2 diabetes. GLP-1RAs should be strongly considered where cardiovascular protection is a priority, while SGLT2is remain valuable alternatives, particularly in younger patients. Clinicians must balance efficacy with factors such as cost, availability and additional benefits, including renal outcomes. As precision medicine advances, tailoring glucose-lowering therapy based on cardiovascular risk profiles may improve longevity and quality of life for millions with diabetes.
Reference
Neugebauer R et al. Glucose-lowering medication classes and cardiovascular outcomes in patients with type 2 diabetes. JAMA Netw Open. 2025;8(10):e2536100.
