Liraglutide and Cardiovascular Outcomes in Type 2 Diabetes.
The cardiovascular effect of liraglutide, a glucagon-like peptide 1 analogue, when added to standard care in patients with type 2 diabetes, remains unknown.



In this double-blind trial, we randomly assigned patients with type 2 diabetes and high cardiovascular risk to receive liraglutide or placebo. The primary composite outcome in the time-to-event analysis was the first occurrence of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke. The primary hypothesis was that liraglutide would be noninferior to placebo with regard to the primary outcome, with a margin of 1.30 for the upper boundary of the 95% confidence interval of the hazard ratio. No adjustments for multiplicity were performed for the prespecified exploratory outcomes.



A total of 9340 patients underwent randomization. The median follow-up was 3.8 years. The primary outcome occurred in significantly fewer patients in the liraglutide group (608 of 4668 patients [13.0%]) than in the placebo group (694 of 4672 [14.9%]) (hazard ratio, 0.87; 95% confidence interval [CI], 0.78 to 0.97; P<0.001 for noninferiority; P=0.01 for superiority). Fewer patients died from cardiovascular causes in the liraglutide group (219 patients [4.7%]) than in the placebo group (278 [6.0%]) (hazard ratio, 0.78; 95% CI, 0.66 to 0.93; P=0.007). The rate of death from any cause was lower in the liraglutide group (381 patients [8.2%]) than in the placebo group (447 [9.6%]) (hazard ratio, 0.85; 95% CI, 0.74 to 0.97; P=0.02). The rates of nonfatal myocardial infarction, nonfatal stroke, and hospitalization for heart failure were nonsignificantly lower in the liraglutide group than in the placebo group. The most common adverse events leading to the discontinuation of liraglutide were gastrointestinal events. The incidence of pancreatitis was nonsignificantly lower in the liraglutide group than in the placebo group.



In the time-to-event analysis, the rate of the first occurrence of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke among patients with type 2 diabetes mellitus was lower with liraglutide than with placebo. (Funded by Novo Nordisk and the National Institutes of Health; LEADER ClinicalTrials.gov number, NCT01179048.).
From the University of Texas Southwestern Medical Center, Dallas (S.P.M.); Massachusetts General Hospital, Boston (G.H.D.); Novo Nordisk, Bagsvaerd, Denmark (K.B.-F., P.K., L.S.R., M.S.); Friedrich Alexander University of Erlangen, Erlangen (J.F.E.M.), and St. Josef Hospital, Ruhr University, Bochum (M.A.N.) - both in Germany; Cleveland Clinic, Cleveland (S.E.N.); London School of Hygiene and Tropical Medicine Medical Statistics Unit (S.P.) and Imperial College London (N.R.P.), London; George Washington University Medical Center, Washington, DC (W.M.S.); Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, University of Toronto, Toronto (B.Z.); International Diabetes Center at Park Nicollet, Minneapolis (R.M.B.); and the University of North Carolina School of Medicine, Chapel Hill (J.B.B.).
Steven P
SP
Marso
From the University of Texas Southwestern Medical Center, Dallas (S.P.M.); Massachusetts General Hospital, Boston (G.H.D.); Novo Nordisk, Bagsvaerd, Denmark (K.B.-F., P.K., L.S.R., M.S.); Friedrich Alexander University of Erlangen, Erlangen (J.F.E.M.), and St. Josef Hospital, Ruhr University, Bochum (M.A.N.) - both in Germany; Cleveland Clinic, Cleveland (S.E.N.); London School of Hygiene and Tropical Medicine Medical Statistics Unit (S.P.) and Imperial College London (N.R.P.), London; George Washington University Medical Center, Washington, DC (W.M.S.); Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, University of Toronto, Toronto (B.Z.); International Diabetes Center at Park Nicollet, Minneapolis (R.M.B.); and the University of North Carolina School of Medicine, Chapel Hill (J.B.B.).
Gilbert H
GH
Daniels
From the University of Texas Southwestern Medical Center, Dallas (S.P.M.); Massachusetts General Hospital, Boston (G.H.D.); Novo Nordisk, Bagsvaerd, Denmark (K.B.-F., P.K., L.S.R., M.S.); Friedrich Alexander University of Erlangen, Erlangen (J.F.E.M.), and St. Josef Hospital, Ruhr University, Bochum (M.A.N.) - both in Germany; Cleveland Clinic, Cleveland (S.E.N.); London School of Hygiene and Tropical Medicine Medical Statistics Unit (S.P.) and Imperial College London (N.R.P.), London; George Washington University Medical Center, Washington, DC (W.M.S.); Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, University of Toronto, Toronto (B.Z.); International Diabetes Center at Park Nicollet, Minneapolis (R.M.B.); and the University of North Carolina School of Medicine, Chapel Hill (J.B.B.).
Kirstine
K
Brown-Frandsen
From the University of Texas Southwestern Medical Center, Dallas (S.P.M.); Massachusetts General Hospital, Boston (G.H.D.); Novo Nordisk, Bagsvaerd, Denmark (K.B.-F., P.K., L.S.R., M.S.); Friedrich Alexander University of Erlangen, Erlangen (J.F.E.M.), and St. Josef Hospital, Ruhr University, Bochum (M.A.N.) - both in Germany; Cleveland Clinic, Cleveland (S.E.N.); London School of Hygiene and Tropical Medicine Medical Statistics Unit (S.P.) and Imperial College London (N.R.P.), London; George Washington University Medical Center, Washington, DC (W.M.S.); Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, University of Toronto, Toronto (B.Z.); International Diabetes Center at Park Nicollet, Minneapolis (R.M.B.); and the University of North Carolina School of Medicine, Chapel Hill (J.B.B.).
Peter
P
Kristensen
From the University of Texas Southwestern Medical Center, Dallas (S.P.M.); Massachusetts General Hospital, Boston (G.H.D.); Novo Nordisk, Bagsvaerd, Denmark (K.B.-F., P.K., L.S.R., M.S.); Friedrich Alexander University of Erlangen, Erlangen (J.F.E.M.), and St. Josef Hospital, Ruhr University, Bochum (M.A.N.) - both in Germany; Cleveland Clinic, Cleveland (S.E.N.); London School of Hygiene and Tropical Medicine Medical Statistics Unit (S.P.) and Imperial College London (N.R.P.), London; George Washington University Medical Center, Washington, DC (W.M.S.); Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, University of Toronto, Toronto (B.Z.); International Diabetes Center at Park Nicollet, Minneapolis (R.M.B.); and the University of North Carolina School of Medicine, Chapel Hill (J.B.B.).
Johannes F E
JF
Mann
From the University of Texas Southwestern Medical Center, Dallas (S.P.M.); Massachusetts General Hospital, Boston (G.H.D.); Novo Nordisk, Bagsvaerd, Denmark (K.B.-F., P.K., L.S.R., M.S.); Friedrich Alexander University of Erlangen, Erlangen (J.F.E.M.), and St. Josef Hospital, Ruhr University, Bochum (M.A.N.) - both in Germany; Cleveland Clinic, Cleveland (S.E.N.); London School of Hygiene and Tropical Medicine Medical Statistics Unit (S.P.) and Imperial College London (N.R.P.), London; George Washington University Medical Center, Washington, DC (W.M.S.); Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, University of Toronto, Toronto (B.Z.); International Diabetes Center at Park Nicollet, Minneapolis (R.M.B.); and the University of North Carolina School of Medicine, Chapel Hill (J.B.B.).
Michael A
MA
Nauck
From the University of Texas Southwestern Medical Center, Dallas (S.P.M.); Massachusetts General Hospital, Boston (G.H.D.); Novo Nordisk, Bagsvaerd, Denmark (K.B.-F., P.K., L.S.R., M.S.); Friedrich Alexander University of Erlangen, Erlangen (J.F.E.M.), and St. Josef Hospital, Ruhr University, Bochum (M.A.N.) - both in Germany; Cleveland Clinic, Cleveland (S.E.N.); London School of Hygiene and Tropical Medicine Medical Statistics Unit (S.P.) and Imperial College London (N.R.P.), London; George Washington University Medical Center, Washington, DC (W.M.S.); Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, University of Toronto, Toronto (B.Z.); International Diabetes Center at Park Nicollet, Minneapolis (R.M.B.); and the University of North Carolina School of Medicine, Chapel Hill (J.B.B.).
Steven E
SE
Nissen
From the University of Texas Southwestern Medical Center, Dallas (S.P.M.); Massachusetts General Hospital, Boston (G.H.D.); Novo Nordisk, Bagsvaerd, Denmark (K.B.-F., P.K., L.S.R., M.S.); Friedrich Alexander University of Erlangen, Erlangen (J.F.E.M.), and St. Josef Hospital, Ruhr University, Bochum (M.A.N.) - both in Germany; Cleveland Clinic, Cleveland (S.E.N.); London School of Hygiene and Tropical Medicine Medical Statistics Unit (S.P.) and Imperial College London (N.R.P.), London; George Washington University Medical Center, Washington, DC (W.M.S.); Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, University of Toronto, Toronto (B.Z.); International Diabetes Center at Park Nicollet, Minneapolis (R.M.B.); and the University of North Carolina School of Medicine, Chapel Hill (J.B.B.).
Stuart
S
Pocock
From the University of Texas Southwestern Medical Center, Dallas (S.P.M.); Massachusetts General Hospital, Boston (G.H.D.); Novo Nordisk, Bagsvaerd, Denmark (K.B.-F., P.K., L.S.R., M.S.); Friedrich Alexander University of Erlangen, Erlangen (J.F.E.M.), and St. Josef Hospital, Ruhr University, Bochum (M.A.N.) - both in Germany; Cleveland Clinic, Cleveland (S.E.N.); London School of Hygiene and Tropical Medicine Medical Statistics Unit (S.P.) and Imperial College London (N.R.P.), London; George Washington University Medical Center, Washington, DC (W.M.S.); Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, University of Toronto, Toronto (B.Z.); International Diabetes Center at Park Nicollet, Minneapolis (R.M.B.); and the University of North Carolina School of Medicine, Chapel Hill (J.B.B.).
Neil R
NR
Poulter
From the University of Texas Southwestern Medical Center, Dallas (S.P.M.); Massachusetts General Hospital, Boston (G.H.D.); Novo Nordisk, Bagsvaerd, Denmark (K.B.-F., P.K., L.S.R., M.S.); Friedrich Alexander University of Erlangen, Erlangen (J.F.E.M.), and St. Josef Hospital, Ruhr University, Bochum (M.A.N.) - both in Germany; Cleveland Clinic, Cleveland (S.E.N.); London School of Hygiene and Tropical Medicine Medical Statistics Unit (S.P.) and Imperial College London (N.R.P.), London; George Washington University Medical Center, Washington, DC (W.M.S.); Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, University of Toronto, Toronto (B.Z.); International Diabetes Center at Park Nicollet, Minneapolis (R.M.B.); and the University of North Carolina School of Medicine, Chapel Hill (J.B.B.).
Lasse S
LS
Ravn
From the University of Texas Southwestern Medical Center, Dallas (S.P.M.); Massachusetts General Hospital, Boston (G.H.D.); Novo Nordisk, Bagsvaerd, Denmark (K.B.-F., P.K., L.S.R., M.S.); Friedrich Alexander University of Erlangen, Erlangen (J.F.E.M.), and St. Josef Hospital, Ruhr University, Bochum (M.A.N.) - both in Germany; Cleveland Clinic, Cleveland (S.E.N.); London School of Hygiene and Tropical Medicine Medical Statistics Unit (S.P.) and Imperial College London (N.R.P.), London; George Washington University Medical Center, Washington, DC (W.M.S.); Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, University of Toronto, Toronto (B.Z.); International Diabetes Center at Park Nicollet, Minneapolis (R.M.B.); and the University of North Carolina School of Medicine, Chapel Hill (J.B.B.).
William M
WM
Steinberg
From the University of Texas Southwestern Medical Center, Dallas (S.P.M.); Massachusetts General Hospital, Boston (G.H.D.); Novo Nordisk, Bagsvaerd, Denmark (K.B.-F., P.K., L.S.R., M.S.); Friedrich Alexander University of Erlangen, Erlangen (J.F.E.M.), and St. Josef Hospital, Ruhr University, Bochum (M.A.N.) - both in Germany; Cleveland Clinic, Cleveland (S.E.N.); London School of Hygiene and Tropical Medicine Medical Statistics Unit (S.P.) and Imperial College London (N.R.P.), London; George Washington University Medical Center, Washington, DC (W.M.S.); Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, University of Toronto, Toronto (B.Z.); International Diabetes Center at Park Nicollet, Minneapolis (R.M.B.); and the University of North Carolina School of Medicine, Chapel Hill (J.B.B.).
Mette
M
Stockner
From the University of Texas Southwestern Medical Center, Dallas (S.P.M.); Massachusetts General Hospital, Boston (G.H.D.); Novo Nordisk, Bagsvaerd, Denmark (K.B.-F., P.K., L.S.R., M.S.); Friedrich Alexander University of Erlangen, Erlangen (J.F.E.M.), and St. Josef Hospital, Ruhr University, Bochum (M.A.N.) - both in Germany; Cleveland Clinic, Cleveland (S.E.N.); London School of Hygiene and Tropical Medicine Medical Statistics Unit (S.P.) and Imperial College London (N.R.P.), London; George Washington University Medical Center, Washington, DC (W.M.S.); Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, University of Toronto, Toronto (B.Z.); International Diabetes Center at Park Nicollet, Minneapolis (R.M.B.); and the University of North Carolina School of Medicine, Chapel Hill (J.B.B.).
Bernard
B
Zinman
From the University of Texas Southwestern Medical Center, Dallas (S.P.M.); Massachusetts General Hospital, Boston (G.H.D.); Novo Nordisk, Bagsvaerd, Denmark (K.B.-F., P.K., L.S.R., M.S.); Friedrich Alexander University of Erlangen, Erlangen (J.F.E.M.), and St. Josef Hospital, Ruhr University, Bochum (M.A.N.) - both in Germany; Cleveland Clinic, Cleveland (S.E.N.); London School of Hygiene and Tropical Medicine Medical Statistics Unit (S.P.) and Imperial College London (N.R.P.), London; George Washington University Medical Center, Washington, DC (W.M.S.); Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, University of Toronto, Toronto (B.Z.); International Diabetes Center at Park Nicollet, Minneapolis (R.M.B.); and the University of North Carolina School of Medicine, Chapel Hill (J.B.B.).
Richard M
RM
Bergenstal
From the University of Texas Southwestern Medical Center, Dallas (S.P.M.); Massachusetts General Hospital, Boston (G.H.D.); Novo Nordisk, Bagsvaerd, Denmark (K.B.-F., P.K., L.S.R., M.S.); Friedrich Alexander University of Erlangen, Erlangen (J.F.E.M.), and St. Josef Hospital, Ruhr University, Bochum (M.A.N.) - both in Germany; Cleveland Clinic, Cleveland (S.E.N.); London School of Hygiene and Tropical Medicine Medical Statistics Unit (S.P.) and Imperial College London (N.R.P.), London; George Washington University Medical Center, Washington, DC (W.M.S.); Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, University of Toronto, Toronto (B.Z.); International Diabetes Center at Park Nicollet, Minneapolis (R.M.B.); and the University of North Carolina School of Medicine, Chapel Hill (J.B.B.).
John B
JB
Buse
D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D004311:Double-Blind Method; D005260:Female; D005767:Gastrointestinal Diseases / Q000139:chemically induced; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000069450:Liraglutide / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D020521:Stroke / Q000453:epidemiology; D016896:Treatment Outcome
D007004:Hypoglycemic Agents; D000069450:Liraglutide