Individuals with metabolic dysfunction–associated steatotic liver disease (MASLD) and type 2 diabetes mellitus (T2DM) face elevated cardiovascular risk, yet comparative cardiovascular outcomes with commonly used glucose-lowering therapies remain uncertain. A retrospective cohort analysis published in Diabetes Research and Clinical Practice evaluated cardiovascular outcomes among adults with MASLD and T2DM initiating glucagon-like peptide-1 receptor agonists (GLP-1 RAs) or sodium–glucose cotransporter-2 inhibitors (SGLT2is) in routine clinical practice.

The study used the TriNetX global health research network and included adults who initiated GLP-1 RA or SGLT2i therapy between 2017 and 2025. After propensity score matching, the analysis included 52,094 patients with a mean age of 58.5 years, of whom 49.7% were women. Median follow-up was 3.0 years. Matching balanced baseline demographics, comorbidities, medications, and laboratory parameters. Outcomes were evaluated using Cox proportional hazards models and Kaplan-Meier survival analysis, with additional landmark analyses, negative control outcomes, and E-value estimation. The analysis also applied target-trial emulation methods to reduce immortal-time and confounding bias.

GLP-1 RA therapy was associated with a lower risk of major adverse cardiovascular and cerebrovascular events compared with SGLT2is (HR 0.86; 95% CI 0.80-0.92; p < 0.001). The analysis also showed lower risks of heart failure, myocardial infarction, stroke, and all-cause mortality among individuals receiving GLP-1 RAs. Results remained consistent across sensitivity analyses. These findings provide real-world comparative evidence on cardiovascular outcomes with GLP-1 RAs and SGLT2is in adults with MASLD and T2DM.