Patients with rheumatoid arthritis (RA) and type 2 diabetes mellitus (T2DM) have elevated cardiovascular risk, although comparative cardiovascular outcomes associated with glucose-lowering therapies in this population remain unclear. A retrospective cohort study published in Journal of Clinical Medicine Research evaluated major adverse cardiovascular events (MACEs) among patients with concurrent RA and T2DM receiving sodium-glucose co-transporter 2 (SGLT2) inhibitors or dipeptidyl peptidase-4 (DPP-4) inhibitors.

The study used data from the TriNetX US Collaborative Network, including 67 healthcare organizations. Adults with documented RA and T2DM prescribed either SGLT2 inhibitors or DPP-4 inhibitors between 2006 and 2026 were identified. After propensity score matching for demographics and comorbidities, 277 matched pairs were included. The primary endpoint was a composite MACE outcome including myocardial infarction, cerebral infarction, heart failure, cardiovascular death, and cardiac arrest.

Findings

• After propensity score matching, baseline characteristics were balanced between treatment groups.
• The SGLT2 inhibitor cohort demonstrated numerically lower MACE incidence than the DPP-4 inhibitor cohort (43.0% vs 48.7%), although the difference was not statistically significant (P = 0.172).
• Kaplan-Meier analyses demonstrated borderline differences in event-free survival between groups (log-rank P = 0.051).
• Median follow-up duration differed substantially between groups at 3.1 years for SGLT2 inhibitor users and 6.4 years for DPP-4 inhibitor users.
• Violation of the proportional hazards assumption limited interpretation of Cox regression hazard ratio estimates.

The analysis demonstrated numerically lower but statistically non-significant MACE incidence among SGLT2 inhibitor users with RA and T2DM compared with DPP-4 inhibitor users. These findings remain hypothesis-generating and require confirmation in larger prospective studies with standardized follow-up durations.