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Cardiovascular and mortality outcomes with GLP-1 receptor agonists vs other glucose-lowering drugs in individuals with NAFLD and type 2 diabetes: a large population-based matched cohort study – published online 20/12/2023

Krishnan graphical abstract

Arunkumar Krishnan, Carolin V. Schneider, Yousaf Hadi, Diptasree Mukherjee, Bandar AlShehri,·Saleh A Alqahtani

Current evidence highlights a strong association between CVD and non-alcoholic fatty liver disease (NAFLD). The presence of NAFLD in association with type 2 diabetes worsens the metabolic profile and exacerbates the risk of CVD. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have been reported to effectively reduce the incidence of major adverse cardiovascular events (MACE) in individuals with type 2 diabetes or NAFLD. However, the specific impact of GLP-1RAs on cardiovascular risk in individuals with both NAFLD and concurrent type 2 diabetes remains unclear. In this issue, Krishnan et al (https://doi.org/10.1007/s00125-023-06057-5) reveal that, among people with both NAFLD and type 2 diabetes, new GLP-1RA users experienced a lower incidence of MACE, cerebrovascular events, heart failure and mortality than those taking other glucose-lowering medications, with outcomes comparable to those in users of sodium-glucose cotransporter-2 (SGLT2) inhibitors. The findings suggest that early initiation of GLP-1RAs or SGLT2 inhibitors in individuals with NAFLD and type 2 diabetes has potential cardioprotective benefits. The authors conclude that regular cardiovascular risk assessments and prompt incorporation of either of these drugs are crucial for mitigating risks in these individuals. In addition, comparison of the effects of these two drugs may allow drug selection to be personalised based on individual patient needs.

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