Lower risk of heart failure and stroke with exenatide than with insulin

In patients with type 2 diabetes, treatment with exenatide has shown beneficial effects on cardiovascular risk factors. A recent study used the GE Healthcare database to evaluate the risk of heart failure, myocardial infarction, and stroke in 2,795 patients taking exenatide twice daily and in 51,547 patients taking insulin in routine clinical practice.

The study was presented in June at the American Diabetes Association 73rd Scientific Sessions, in Chicago.

In this study, a group of 54,342 patients who were taking exenatide or insulin combined with oral anti-diabetes agents was followed for at least 3 years. Of this group, 39% of patients taking exenatide and 47% of patients taking insulin were men. The median age of the exenatide group was 56 years, and the median age of the insulin group was 59 years. Fifty-four percent of patients in the exenatide group and 48% of patients in the insulin group were white. Eleven percent of patients in the exenatide group and 12% of patients in the insulin group had a history of cardiovascular disease. Eighty-nine percent of those in the exenatide group and 61% of those in the insulin group were taking metformin.

During the median 4.3-year follow-up for patients taking exenatide and 4.2-year follow-up for those taking insulin, 2.1% of those taking exenatide and 5.8% of those taking insulin had heart failure, 0.5% of those taking exenatide and 0.9% of those taking insulin had myocardial infarction, and 0.9% of those taking exenatide and 2.1% of those taking insulin suffered a stroke.

Cardiovascular event rates per 1,000 person-years were significantly lower among patients treated with exenatide compared with those treated with insulin. Rates of heart failure were 4.8 in the exenatide group and 13.6 in the insulin group. Rates of myocardial infarction were 1.1 in the exenatide group and 2.1 in the insulin group, and the rates of stroke were 2.0 in the exenatide group and 4.9 in the insulin group.

Compared to patients taking insulin, patients treated with exenatide had a significantly lower risk of heart failure (by 53%) and myocardial infarction/stroke (by 48%). Compared to patients with no history of cardiovascular disease, patients with a history of cardiovascular disease had a 47% increased risk of heart failure and a 70% increased risk of myocardial infarction/stroke.