Vrablı́k, Michal

Abstract Background Cardiovascular disease (CVD) is the leading cause of death in patients with type 2 diabetes mellitus (T2DM). Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter 2 inhibitors (SGLT2i) have demonstrated cardiovascular (CV) benefits and are recommended for T2DM patients with atherosclerotic CVD (ASCVD). However, real-world data on their adoption in high-risk populations, particularly myocardial infarction (MI) and stroke survivors, remain limited. Purpose To assess real-world utilization of GLP-1RAs and SGLT2i among T2DM patients with ASCVD focusing on trends, disparities by age, sex, and region from 2015 to 2023. Methods A nationwide cohort study using data from the National Registry of Reimbursed Health Services (2015–2023), covering all reimbursed health services in the Czech Republic. Patients with nonfatal MI (ICD-10: I21, I22) or stroke (I63, I64) and confirmed T2DM were included. Prescriptions were identified at the event or within 12 months post-event. Utilization trends were analyzed, and logistic regression was used to determine predictors of medication use. Results Among 116,218 MI patients (median age:68 years, 33.5% women), 53,128 (46%) had T2DM (median age:71 years, 37% women). Within 12 months post-MI, 2.1% received GLP-1RAs and 10.6% received SGLT2i, with increasing trends from 0.3% (2015) to 4.8% (2023) (GLP-1RAs) and 0.4% (2015) to 34.8% (2023) (SGLT2i). Women were less likely to receive SGLT2i (aOR: 0.70 [95%CI:0.65–0.74]), while no significant difference was observed for GLP-1RAs (aOR:0.98 [95%CI:0.86–1.12]). Older patients (>70 years) had lower odds of receiving GLP-1RAs (aOR:0.31 [95%CI:0.27–0.36]) and SGLT2i (aOR:0.53 [95%CI:0.50–0.56]). Prescription rates were highest in Prague (3.1% GLP-1RAs; 13.5% SGLT2i) and lowest in the Moravian-Silesian Region (1.4% GLP-1RAs; 8.8% SGLT2i). Among 164,729 stroke patients (median age:73 years, 49% women), 78,562 (48%) had T2DM (median age:75 years, 50% women). Within 12 months post-stroke, 1.2% received GLP-1RAs and 3.7% received SGLT2i, with increasing trends from 0.2% (2015) to 2.8% (2023) (GLP-1RAs) and 0.1% (2015) to 10.4% (2023) (SGLT2i). Women were less likely to receive GLP-1RAs (aOR:0.82 [95%CI:0.72–0.95]) and SGLT2i (aOR:0.57 [95%CI:0.52–0.62]). Older patients (>70 years) had lower odds of receiving GLP-1RAs (aOR:0.31 [95%CI:0.27–0.36]) and SGLT2i (aOR:0.40 [95%CI:0.37–0.44]). Regional disparities were notable, with prescription rates varying from 0.8–2.1% (GLP-1RAs) and 2.4–5.2% (SGLT2i). Conclusions Prescribing rates for GLP-1RAs and SGLT2i have increased over the past eight years but remain low, even among MI and stroke survivors. Women, older patients, and those in lower-income regions are significantly less likely to receive these therapies. Targeted interventions are needed to improve secondary prevention in high-risk diabetic populations and to address these disparities.Myocardial infarction patients Stroke patients

Abstract Aims Glucagon-like peptide-1 receptor agonists (GLP-1RA) reduce cardiovascular risk in patients with Type 2 diabetes (T2D) and established atherosclerotic cardiovascular disease and are recommended in guidelines. We evaluated the real-world effectiveness of GLP-1RA therapy on cardiovascular outcomes in patients with T2D after myocardial infarction (MI) or ischaemic stroke and examined trends and disparities. Methods and results Using nationwide Czech registry data (2015–24), we identified patients with incident nonfatal MI or ischaemic stroke and confirmed T2D. GLP-1RA users—initiating therapy within 12 months post-event—were propensity score matched to non-users. The primary outcome was major adverse cardiovascular events (MACE: nonfatal MI, nonfatal stroke, cardiovascular death); secondary outcomes included individual components and all-cause mortality. GLP-1RA therapy was initiated in only ∼2% of MI and stroke survivors with T2D. Among 126 845 MI survivors, 28 206 had T2D; the matched cohort comprised 2271 patients (401 GLP-1RA; median follow-up 35 months). GLP-1RA use was associated with lower risk of MACE (HR 0.7; 95% CI, 0.52–0.93), all-cause (HR 0.61; 95% CI, 0.47–0.80), and cardiovascular death (HR 0.54; 95% CI, 0.36–0.80). Among 177 115 stroke survivors, 73 750 had T2D; the matched cohort comprised 2235 patients (385 GLP-1RA; median follow-up 27 months). GLP-1RA use was associated with lower risk of MACE (HR 0.71; 95% CI, 0.54–0.94), all-cause (HR 0.59; 95% CI, 0.46–0.76), and cardiovascular death (HR 0.55; 95% CI, 0.37–0.81). Conclusion GLP-1RA therapy after MI or stroke in T2D was associated with substantially lower risks of MACE, cardiovascular, and all-cause death in real-world practice. Utilization remained low, particularly among women and older adults, underscoring the need for broader and more equitable implementation in secondary prevention.

Abstract Background Throughout the COVID-19 pandemic many countries reported a decline in myocardial infarction (MI) and stroke admissions. Factors leading to the decline remain uncertain. Purpose In this nationwide study spanning the first two years of the COVID-19 pandemic we evaluated the changes in MI and stroke admissions as the effect of pandemic intensity and nationwide lockdown. We also investigated sex and age differences. We benefited from the fact that the Czech Republic had both, the lowest and one of the highest COVID-19 incidence. Methods We compared the first (March 1, 2020, to February 28, 2021) and the second (March 1, 2021, to February 28, 2022) pandemic years overall and during the COVID-19 waves with the preceding year (March 1, 2019, to February 28, 2020). The occurrence of MI and stroke, patient characteristics, and mortality data were obtained from two nationwide registers covering every hospitalization and every death in the Czech Republic. Results During the first and second pandemic year as compared to the preceding year there were 13,856 and 14,123 vs 15,499 MI admissions, representing a -10,6% (p<0.001) and -8,9% (p<0.001) decline; and 23,194 and 23,231 vs 25,046 stroke admissions, representing a -7.4% (p<0.001) and -7.2% (p<0.001) decline respectively. The significant decline appeared in both MI and stroke in all COVID-19 waves (spring 2020, spring 2021, autumn 2020/winter 2021, -autumn 2021/winter 2022). The greatest MI hospitalization decline (-16%) occurred during the first strict national lock down, during the first COVID-19 wave (spring 2020), the pandemic wave with the lowest COVID-19 incidence. Both, MI and stroke admissions reversed to pre-pandemic numbers during the summer (2020, 2021) when most lockdown restrictions were lifted. The decline in MI was greater in women than in men during both the first (-11.8%, -10%; p<0.001) and second (-10.8%, -7.9%; p<0.001) pandemic years, also for stroke in women greater than in men during the first (-9%, -5.9%; p<0.001) and second (-9.7%, -4.8%; p<0.001) pandemic years. The 30-day all-cause mortality in patients with MI was higher during the first (10.6%; p<0.001) but not the second (9.6%; p=0.34) pandemic year as compared to the preceding year (9.3%), whereas the 30-day mortality in patients with stroke remained unchanged. Conclusions There was a decline in both MI and stroke admissions during the first two years of the pandemic, but such decline was not related to COVID-19 incidence. The greatest reduction in both, MI and stroke admissions, appeared during the first lockdown in the first COVID-19 wave (spring 2020), the period of the lowest COVID-19 incidence. Moreover, the decline in MI and stroke admissions was greater in women. This highlights potential sex differences in health effect. Health authorities should be aware of these findings, in order to adapt their message and restriction measures in case of future major epidemics.Myocardial infarction casesStroke cases

Aim The objective was to examine the prevalence of atherosclerotic cardiovascular disease (ASCVD) and its risk factors among patients with RA with diabetes mellitus (RA-DM) and patients with RA without diabetes mellitus (RAwoDM), and to evaluate lipid and blood pressure (BP) goal attainment in RA-DM and RAwoDM in primary and secondary prevention. Methods The cohort was derived from the Survey of Cardiovascular Disease Risk Factors in Patients with Rheumatoid Arthritis from 53 centres/19 countries/3 continents during 2014–2019. We evaluated the prevalence of cardiovascular disease (CVD) among RA-DM and RAwoDM. The study population was divided into those with and without ASCVD, and within these groups we compared risk factors and CVD preventive treatment between RA-DM and RAwoDM. Results The study population comprised of 10 543 patients with RA, of whom 1381 (13%) had DM. ASCVD was present in 26.7% in RA-DM compared with 11.6% RAwoDM (p<0.001). The proportion of patients with a diagnosis of hypertension, hyperlipidaemia and use of lipid-lowering or antihypertensive agents was higher among RA-DM than RAwoDM (p<0.001 for all). The majority of patients with ASCVD did not reach the lipid goal of low-density lipoprotein cholesterol <1.8 mmol/L. The lipid goal attainment was statistically and clinically significantly higher in RA-DM compared with RAwoDM both for patients with and without ASCVD. The systolic BP target of <140 mm Hg was reached by the majority of patients, and there were no statistically nor clinically significant differences in attainment of BP targets between RA-DM and RAwoDM. Conclusion CVD preventive medication use and prevalence of ASCVD were higher in RA-DM than in RAwoDM, and lipid goals were also more frequently obtained in RA-DM. Lessons may be learnt from CVD prevention programmes in DM to clinically benefit patients with RA .

Abstract Aims To assess differences in estimated cardiovascular disease (CVD) risk among rheumatoid arthritis (RA) patients from different world regions and to evaluate the management and goal attainment of lipids and blood pressure (BP). Methods and results The survey of CVD risk factors in patients with RA was conducted in 14 503 patients from 19 countries during 2014–19. The treatment goal for BP was &lt;140/90 mmHg. CVD risk prediction and lipid goals were according to the 2016 European guidelines. Overall, 21% had a very high estimated risk of CVD, ranging from 5% in Mexico, 15% in Asia, 19% in Northern Europe, to 31% in Central and Eastern Europe and 30% in North America. Of the 52% with indication for lipid-lowering treatment (LLT), 44% were using LLT. The lipid goal attainment was 45% and 18% in the high and very high risk groups, respectively. Use of statins in monotherapy was 24%, while 1% used statins in combination with other LLT. Sixty-two per cent had hypertension and approximately half of these patients were at BP goal. The majority of the patients used antihypertensive treatment in monotherapy (24%), while 10% and 5% as a two- or three-drug combination. Conclusion We revealed considerable geographical differences in estimated CVD risk and preventive treatment. Low goal attainment for LLT was observed, and only half the patients obtained BP goal. Despite a high focus on the increased CVD risk in RA patients over the last decade, there is still substantial potential for improvement in CVD preventive measures.