Paradoxical real-life underuse of GLP-1 receptor agonists in type 2 diabetes patients with atherosclerotic cardiovascular disease Underuse of GLP-1RAs in patients with ASCVD

Introduction: Glucagon-like peptide -1 receptor agonists (GLP-1RAs) reduce the risk of cardiovascular (CV) complications in patients with type 2 diabetes (T2DM) and atherosclerotic cardiovascular disease (ASCVD) in placebo -controlled CV outcome trials, yet the use of these cardioprotective agents remains rather low in clinical practice. Methods: Analysis of the proportion of T2DM patients treated with GLP-1RAs in retrospective observational studies by comparing patients with versus without established ASCVD. Results: Nine cohorts from seven studies were collected in the international literature between 2019 and 2022. Overall, the percentages of patients treated with GLP-1RAs were low (< 10 %) in most studies, yet a progressive increase was noticed over time. The use of GLP-1RAs in patients with ASCVD was slightly lower in 7 out of 9 cohorts not higher when compared to the use in patients without ASCVD (odds ratio 0.80, 95 % CI 0.79-0.81). Conclusion: Despite a positive trend over the last decade, the real -world use of GLP-1RAs remains limited, especially in patients with established ASCVD. Bridging the gap between clinical evidence of cardioprotective effects of GLP-1RAs and their underuse in clinical practice in T2DM patients at high/very high CV risk should be considered as a key objective for health care providers, especially cardiologists. (c) 2024 The Author(s). Published by Elsevier Masson SAS. This is an open access article under the CC BY -NCND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)