GLP-1 receptor agonists were associated with 52% lower mortality and 34% fewer cardiovascular events compared to DPP-4 inhibitors in over 10,000 people with autoimmune diseases and type 2 diabetes.
52% lower mortalityGLP-1 receptor agonists vs DPP-4 inhibitors in over 10,000 patients with autoimmune inflammatory diseases and type 2 diabetes
What the researchers found
In 10,855 adults with autoimmune inflammatory diseases and type 2 diabetes, initiating GLP-1 receptor agonists was associated with 52% lower all-cause mortality (HR 0.48, 95% CI 0.31-0.75) and 34% lower major adverse cardiovascular events (HR 0.66, 95% CI 0.50-0.88) compared to DPP-4 inhibitors. This translated to 9.4 fewer deaths and 10.5 fewer cardiovascular events per 1,000 person-years. The benefit was similar in matched adults without autoimmune diseases.
Why it matters
Patients with autoimmune inflammatory diseases (rheumatoid arthritis, IBD, psoriasis, etc.) have elevated cardiovascular risk. This is the first large population study to show that GLP-1 peptide drugs provide substantial mortality and cardiovascular benefits specifically in this high-risk autoimmune population — potentially due to both metabolic and anti-inflammatory effects of GLP-1 receptor agonists.
The numbers in context
n=10,855 · HR mortality 0.48 (52% reduction) · HR MACE 0.66 (34% reduction) · RD -9.4 deaths/1000 PY · RD -10.5 MACE/1000 PY · 2010-2021 · 5 autoimmune diseases
How the study worked
Population-based cohort study using administrative health data from British Columbia, Canada (2010-2021). Patients with an autoimmune inflammatory disease (RA, psoriatic disease, ankylosing spondylitis, IBD, or systemic autoimmune rheumatic disease) and type 2 diabetes who newly started GLP-1 RAs or DPP-4 inhibitors were identified via ICD codes. Propensity score overlap weighting and Cox regression were used. Analysis was repeated in matched adults without autoimmune diseases.
Who was studied
10,855 adults in British Columbia with autoimmune inflammatory diseases and type 2 diabetes who newly initiated GLP-1 RAs or DPP-4 inhibitors
What this study cannot tell us
Observational study — cannot prove causation despite propensity score weighting. Administrative data may have coding inaccuracies. Specific GLP-1 RA drugs and doses not differentiated. Healthy user bias possible (healthier patients may be preferentially prescribed GLP-1 RAs). Relatively short median follow-up not specified in abstract. No data on weight changes, HbA1c, or inflammatory markers.
How to read the evidence
This is a large population-based cohort study with propensity score weighting and an active comparator (DPP-4 inhibitors), which is a strong observational design. However, as a non-randomized study, residual confounding cannot be eliminated. The large sample size and consistent results across subgroups strengthen the findings.
When this study was published
Published in 2024, this study adds autoimmune disease patients to the growing evidence base for cardiovascular benefits of GLP-1 peptide drugs, complementing the landmark SELECT trial in atherosclerotic disease.
The bigger picture
GLP-1 receptor agonists continue to reveal benefits beyond glucose control. This study extends the cardiovascular evidence to a particularly vulnerable population — people with chronic inflammatory autoimmune diseases. Given that GLP-1 has known anti-inflammatory properties, these peptide drugs may offer dual benefits in autoimmune patients: metabolic improvement plus inflammation modulation. This could reshape how clinicians choose diabetes medications for their autoimmune patients.
Questions still open
- Is the mortality benefit driven by GLP-1 receptor agonists' anti-inflammatory effects, cardiovascular protection, weight loss, or a combination?
- Would GLP-1 drugs show benefit in autoimmune disease patients without diabetes — purely for cardiovascular and anti-inflammatory effects?
- Do specific GLP-1 receptor agonists (semaglutide vs liraglutide vs others) differ in their cardiovascular benefit for autoimmune patients?
Common questions
Why are people with autoimmune diseases at higher cardiovascular risk?
What's the difference between GLP-1 receptor agonists and DPP-4 inhibitors?
Read the original research
Mortality and major adverse cardiovascular events after glucagon-like peptide-1 receptor agonist initiation in patients with immune-mediated inflammatory diseases and type 2 diabetes: A population-based study.
PloS one, 19(8), e0308533
Citation
Karacabeyli, Derin; Lacaille, Diane; Lu, Na; McCormick, Natalie; Xie, Hui; Choi, Hyon K; Aviña-Zubieta, J Antonio. (2024). Mortality and major adverse cardiovascular events after glucagon-like peptide-1 receptor agonist initiation in patients with immune-mediated inflammatory diseases and type 2 diabetes: A population-based study.. PloS one, 19(8), e0308533. https://doi.org/10.1371/journal.pone.0308533