Table 3.
Cox proportional hazards models for filling a new prescription for a GLP1-RA or an SGLT2i among patients with ASCVD and for an SGLT2i among patients with CHF
| ASCVD cohort | CHF cohort | |||
|---|---|---|---|---|
| HR (95% CI) | P | HR (95% CI) | P | |
| Age | 0.939 (0.94–0.94) | <0.0001 | 0.949 (0.95–0.95) | <0.0001 |
| Male | 1.081 (1.06–1.1) | <0.0001 | 1.199 (1.13–1.27) | <0.0001 |
| Year of cohort entry | ||||
| 2016 | Ref | Ref | ||
| 2017 | 1.447 (1.42–1.48) | <0.0001 | 1.395 (1.30–1.50) | <0.0001 |
| 2018 | 1.828 (1.79–1.87) | <0.0001 | 1.697 (1.57–1.83) | <0.0001 |
| 2019 | 2.241 (2.19–2.29) | <0.0001 | 2.803 (2.61–3.01) | <0.0001 |
| Race/ethnicity | ||||
| Non-Hispanic White | Ref | Ref | ||
| Non-Hispanic Black | 0.811 (0.79–0.84) | <0.0001 | 0.818 (0.74–0.90) | <0.0001 |
| Hispanic | 0.995 (0.95–1.04) | 0.8294 | 1.182 (1.03–1.36) | 0.0183 |
| Asian | 1.034 (0.99–1.08) | 0.1423 | 1.294 (1.13–1.48) | 0.0002 |
| Other | 0.842 (0.75–0.95) | 0.0038 | 0.777 (0.54–1.11) | 0.1709 |
| Missing | 1.025 (0.99–1.07) | 0.2191 | 1.220 (1.08–1.38) | 0.0014 |
| SDI, per SD28 | 0.964 (0.96–0.97) | <0.0001 | 0.991 (0.96–1.02) | 0.529 |
| Region | ||||
| South | Ref | Ref | ||
| Northeast | 0.929 (0.91–0.95) | <0.0001 | 0.964 (0.90–1.04) | 0.3286 |
| Midwest | 0.813 (0.80–0.83) | <0.0001 | 0.793 (0.74–0.85) | <0.0001 |
| West | 1.060 (1.04–1.09) | <0.0001 | 1.142 (1.06–1.23) | 0.0003 |
| Comorbidities | ||||
| Hypertension | 1.070 (1.04–1.10) | <0.0001 | 1.016 (0.93–1.12) | 0.7367 |
| Hyperlipidemia | 1.101 (1.07–1.13) | <0.0001 | 1.123 (1.04–1.21) | 0.0019 |
| Atrial fibrillation/flutter | 0.947 (0.92–0.97) | <0.0001 | 0.943 (0.89–1.00) | 0.0571 |
| Obesity | 1.375 (1.35–1.40) | <0.0001 | 1.128 (1.07–1.19) | <0.0001 |
| Cirrhosis | 0.842 (0.79–0.90) | <0.0001 | 0.924 (0.77–1.11) | 0.4017 |
| NAFLD, hepatosteatosis | 1.231 (1.18–1.28) | <0.0001 | 1.265 (1.11–1.45) | 0.0006 |
| Tobacco use | 0.855 (0.82–0.89) | <0.0001 | 1.034 (0.91–1.18) | 0.6166 |
| Alcohol use | 0.841 (0.77–0.92) | <0.0001 | 0.977 (0.78–1.22) | 0.8398 |
| Diabetes complications | ||||
| Neuropathy | 1.221 (1.19–1.25) | <0.0001 | 1.202 (1.12–1.29) | <0.0001 |
| Retinopathy | 1.179 (1.15–1.21) | <0.0001 | 1.093 (1.01–1.18) | 0.0255 |
| Nephropathy | 1.16 (1.12–1.20) | <0.0001 | 0.956 (0.85–1.07) | 0.4349 |
| Comorbidity indices | ||||
| Gagne index | 0.982 (0.98–0.99) | <0.0001 | 0.958 (0.94–0.97) | <0.0001 |
| Frailty index | 0.773 (0.58–1.04) | 0.087 | 0.331 (0.13–0.85) | 0.0223 |
| SGLT2i contraindications | ||||
| Diabetic ketoacidosis | 1.107 (0.93–1.32) | 0.2576 | 1.722 (1.13–2.62) | 0.0113 |
| Urinary tract infection | 0.948 (0.92–0.97) | <0.0001 | 0.872 (0.80–0.95) | 0.0009 |
| Cellulitis of the groin or Fournier gangrene | 1.389 (1.31–1.47) | <0.0001 | 1.447 (1.19–1.76) | 0.0002 |
| Nontraumatic amputation | 0.935 (0.84–1.04) | 0.2096 | 1.013 (0.66–1.56) | 0.9548 |
| Hypotension | 0.904 (0.86–0.95) | <0.0001 | 1.045 (0.93–1.18) | 0.4698 |
| Falls | 0.986 (0.95–1.02) | 0.4711 | 0.927 (0.82–1.04) | 0.2066 |
| Fracture | 1.000 (0.97–1.03) | 0.9874 | 1.022 (0.94–1.12) | 0.6323 |
| GLP1-RA contraindications | ||||
| Pancreatitis | 0.88 (0.80–0.97) | 0.0118 | 1.219 (0.93–1.60) | 0.1495 |
| Cholelithiasis, cholecystitis | 0.846 (0.8–0.89) | <0.0001 | 0.771 (0.65–0.91) | 0.0028 |
| Medullary thyroid cancer | 1.710 (0.43–6.84) | 0.4482 | 0 (0–1.11 × 10193) | 0.9696 |
| SGLT2i and GLP1-RA relative contraindication | ||||
| Chronic kidney disease, stage 4 | 0.992 (0.97–1.02) | 0.5363 | 0.752 (0.70–0.81) | <0.0001 |
| Diabetes medications | ||||
| Metformin | 1.412 (1.37–1.46) | <0.0001 | 1.936 (1.75–2.14) | <0.0001 |
| Sulfonylureas | 1.607 (1.55–1.66) | <0.0001 | 1.769 (1.59–1.97) | <0.0001 |
| Meglitinides | 1.532 (1.44–1.63) | <0.0001 | 1.457 (1.17–1.82) | 0.0009 |
| DPP-4 inhibitors | 1.871 (1.82–1.93) | <0.0001 | 2.485 (2.26–2.74) | <0.0001 |
| Thiazolidinediones | 1.405 (1.35–1.46) | <0.0001 | 1.873 (1.65–2.13) | <0.0001 |
| α-Glucosidase inhibitors | 1.431 (1.29–1.59) | <0.0001 | 1.201 (0.84–1.72) | 0.3197 |
| Amylin analogs | 1.583 (1.00–2.51) | 0.0521 | 0 (0–8.29 × 1092) | 0.9365 |
| Basal insulins | 1.706 (1.65–1.77) | <0.0001 | 1.284 (1.14–1.44) | <0.0001 |
| Bolus insulins | 1.166 (1.12–1.21) | <0.0001 | 1.273 (1.11–1.46) | 0.0005 |
| Mixed insulins | 1.389 (1.32–1.46) | <0.0001 | 1.181 (0.99–1.42) | 0.071 |
| Cardiovascular medications | ||||
| β-Blockers | 1.026 (1.01–1.04) | 0.0036 | 1.003 (0.95–1.06) | 0.9129 |
| ACE inhibitors, ARBs | 1.033 (1.01–1.05) | 0.0008 | 1.005 (0.95–1.07) | 0.8804 |
| Mineralocorticoid receptor antagonists | 1.013 (0.98–1.05) | 0.435 | 1.068 (0.99–1.15) | 0.0796 |
| Sacubitril | 1.372 (1.20–1.57) | <0.0001 | 1.424 (1.20–1.69) | <0.0001 |
| Thiazide diuretics | 0.917 (0.90–0.94) | <0.0001 | 1.016 (0.94–1.10) | 0.6783 |
| Loop diuretics | 0.985 (0.96–1.01) | 0.1825 | 0.880 (0.83–0.93) | <0.0001 |
| Calcium channel blockers | 0.892 (0.88–0.91) | <0.0001 | 0.853 (0.80–0.90) | <0.0001 |
| Statins | 1.006 (0.99–1.03) | 0.5306 | 0.986 (0.93–1.05) | 0.6553 |
| Ezetimibe | 1.175 (1.13–1.22) | <0.0001 | 1.166 (1.02–1.33) | 0.0252 |
| PCSK9 inhibitors | 1.877 (1.67–2.10) | <0.0001 | 1.337 (0.79–2.26) | 0.2797 |
| Fibrates | 1.083 (1.05–1.11) | <0.0001 | 1.043 (0.94–1.16) | 0.4277 |
| Niacin | 0.900 (0.81–1.00) | 0.0397 | 0.872 (0.60–1.27) | 0.4708 |
| n-3 formulations | 1.421 (1.36–1.48) | <0.0001 | 1.442 (1.24–1.68) | <0.0001 |
| Bile acid sequestrants | 1.161 (1.08–1.24) | <0.0001 | 1.219 (0.97–1.53) | 0.0877 |
| Use measures | ||||
| Primary care visits, per SD (5 visits) | 0.987 (0.98–1.00) | 0.0034 | 0.981 (0.96–1.01) | 0.1749 |
| Endocrine visits | 1.065 (1.06–1.07) | <0.0001 | 1.050 (1.04–1.06) | <0.0001 |
| Cardiology visits | 1.026 (1.02–1.03) | <0.0001 | 1.020 (1.00–1.04) | 0.0524 |
| ER visits | 0.978 (0.97–0.99) | <0.0001 | 0.991 (0.96–1.02) | 0.5301 |
| Hospitalizations | 0.872 (0.85–0.89) | <0.0001 | 0.936 (0.89–0.99) | 0.0128 |
| Total prescriptions | 1.067 (1.06–1.08) | <0.0001 | 1.000 (0.97–1.04) | 0.9841 |
| Total diabetes prescriptions | 1.094 (1.06–1.12) | <0.0001 | 1.032 (0.94–1.13) | 0.4892 |
Full model (model 4) is adjusted for demographic characteristics, comorbidities, medication use, race/ethnicity, SDI, and health care use measures. ARB, angiotensin II receptor blocker; DPP-4, dipeptidyl peptidase 4; ER, emergency room; NAFLD, nonalcoholic fatty liver disease; PCSK9, proprotein convertase subtilisin/kexin type 9; Ref, reference.