Using Secondary Data to Evaluate Sex-based Heterogeneity of GLP-1 Agonists and SGLT2 Inhibitors on Cardiovascular-Kidney-Metabolic Health (CKMH) Outcomes in Real-world Settings (DASH-CKMH)

NCT07188545 | Active Not Recruiting FDA Drug

• 1 other identifier: STUDY20250372
• Study Type: observational
• Target: 23,280,000
• Locations: 1 country
• Sites: 1

Brief Summary

Complex pathophysiological interactions among obesity, metabolic risk factors, chronic kidney disease (CKD), and the cardiovascular system lead to poor cardiovascular-kidney-metabolic health (CKMH), which is a major determinant of premature morbidity and mortality. Poor CKMH may lead to cardiovascular-kidney-metabolic syndrome (CKMS) - the five-stage framework introduced by The American Heart Association (AHA) which accounts for the critical overlap between cardiorenal syndrome and cardiometabolic disease. Evidence from randomized controlled trials shows glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose co-transporter-2 inhibitors (SGLT2is) may improve CKMH in individuals with Type 2 Diabetes (T2D) and/ or obesity. However, there is modest evidence suggesting differential effectiveness of GLP-1RA and SGLT2i drugs between males and females. The extent of these sex-based differences is currently unknown. In part, this may be due to underrepresentation of females in clinical trials. Exploring sex-based differences in GLP-1RA and SGLT2i treatment on CKMH outcomes is important to inform CKMS treatment and equity in CKMH. Robust secondary data sources present the opportunity to elucidate sex heterogeneity in GLP-1RA and SGLT2i treatment on CKMH outcomes. Using a target-trial emulation design, this study aims to observe differences in long-term CKMH outcomes between patients treated by GLP-1RA and SGLT2i medications versus those treated with active comparator medications, and whether there is an observed interaction between sex and treatment.

Conditions

Cardiovascular Kidney Metabolic Syndrome

Keywords

GLP-1; SGLT-2; CKMS; CKMH; target trial; cardiovascular disease

Outcome Measures

Primary Outcomes (1)

• 3-Point major adverse cardiovascular event (3P-MACE)

  Any of the following events: * Nonfatal myocardial infarction * Nonfatal stroke * Death within 14 days of myocardial infarction, ischemic stroke, heart failure, acute coronary syndrome, coronary artery bypass grafting, or percutaneous coronary intervention

  Up to 5 years

Secondary Outcomes (11)

• All-cause Mortality

  Up to 5 years

• Advancing CKMS stage

  Up to 5 Years

• stroke

  up to 5 years

• Myocardial Infarction

  up to 5 years

• Incident coronary heart disease diagnosis

  up to 5 years

Study Arms (3)

Marketscan Cohort

Merative MarketScan Commercial Claims and Encounters and Medicare Supplemental Databases are nationally representative U.S. claims databases of commercially insured patients. The databases include deidentified inpatient, outpatient, prescription drug, procedure, and enrollment records of beneficiaries, dependents, and retirees covered under a variety of fee-for-service and managed care health plans. This database includes \>250 million privately insured individuals and older individuals enrolled in Medicare with an employer sponsored Medigap plan. Data from 2012 to 2022 will be used in DASH-CKMS.

Drug: Intervention; Drug: Active Comparator

All of Us Cohort

All of Us is a unique de-identified dataset administered by the U.S. National Institutes of Health (NIH) containing data from surveys, genomic analyses, electronic health records (EHR), physical measurements, and wearables to study the full range of factors that influence health and disease. All of Us is committed to recruiting a diverse participant pool that includes groups historically underrepresented in healthcare research. To date, about 45% of All of Us participants are racial and ethnic minorities, and over 80% are underrepresented in biomedical research overall. As of December 2024, there are more than 574,000 patient participants in All of Us who completed baseline surveys, provided physical measurements, and donated at least one biospecimen sample, and nearly 850,000 participants who have consented to join the program.

Drug: Intervention; Drug: Active Comparator

Lifescale Cohort

LifeScale data is an institution-scale clinical data warehouse from the Ohio State University Wexner Medical Center (OSUWMC) and Nationwide Children's Hospital (NCH). The data is a limited de-identified copy of the OSU/NCH Caboodle clinical data warehouse mediated by an honest broker and governed under a comprehensive Institutional Review Board (IRB) protocol.

Drug: Intervention; Drug: Active Comparator

Interventions

Intervention DRUG

GLP-1RA and/or SGLT2i adult users with ≥1 prescription for the intervention GLP-1RA or SGLT2i medications (including combination drugs or mixed therapies with comparator medications). GLP-1RAs include: Exenatide, Liraglutide, Semaglutide, Dulaglutide, Lixisenatide, Albiglutide, Tirzepatide. SGLT2is include: Canagliflozin, Dapagliflozin, Bexagliflozin, Empagliflozin, Ertugliflozin, Sotagliflozin.

All of Us Cohort; Lifescale Cohort; Marketscan Cohort

Active Comparator DRUG

DPP4i or Oral Obesity Agent adult users with ≥1 prescription for the comparator DPP4i or Oral Obesity Agent medications AND no intervention GLP-1RA or SGLT2i prescriptions in first 30 days of follow up. DPP4is include: Alogliptin, Saxagliptin, Linagliptin, Sitagliptin. Oral Obesity Agents include: Orlistat, Naltrexone-bupropion, Phentermine-topiramate, Phentermine, Diethylpropion, Bupropion (off-label), Topiramate (off-label)

All of Us Cohort; Lifescale Cohort; Marketscan Cohort

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

The data for this study comes from claims and electronic health records data sources. MarketScan and All of Us are nationally representative databases, and therefore contain patients from all over the US. LifeScale is a local database from The Ohio State University Wexner Medical Center (OSUWMC) and contains patients who seek care at OSUWMC inpatient and outpatient facilities. Adult patients included in the study have evidence of CKMS stage 1 or 2, ≥1 prescription for a GLP-1RA, SGLT2i, DPP4i, or obesity medication, and at least 180 days of continuous database enrollment prior to the first prescription for any medication of interest. Patients will be excluded if they have evidence of stage 3 or 4 CKMS, cancer, renal replacement therapy, end stage renal disease, or solid organ transplant during the baseline period (180 days prior to index date), any history of type I diabetes, or missing sex information. These study criteria will be applied to each of the sources of secondary data to co

You may qualify if:

• Stage 1 or 2 CKMS at baseline
• At least one prescription for an intervention or comparator medication after CKMS diagnosis
• At least 180 days of continuous enrollment prior to the first prescription for any medication of interest (index date)
• Age 18+ at index date

You may not qualify if:

• Stage 3 or 4 CKMS at baseline
• Medications of interest during baseline period
• Any history of type I diabetes
• Cancer at baseline
• Renal replacement therapy at baseline
• End stage renal disease at baseline
• Solid organ transplant at baseline
• Missing sex

Sponsors & Collaborators

• Ohio State University: lead
• American Heart Association: collaborator

Study Sites (1)

Ohio State University

Columbus, Ohio, 43202, United States

Location

MeSH Terms

Conditions

Cardiovascular Diseases

Interventions

Methods

Intervention Hierarchy (Ancestors)

Investigative Techniques

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: RETROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Associate Professor and Vice Chair for Research

Study Record Dates

• First Submitted: September 16, 2025
• First Posted: September 23, 2025
• Study Start: September 15, 2025
• Primary Completion (Estimated): June 30, 2029
• Study Completion (Estimated): June 30, 2029
• Last Updated: September 23, 2025

Record last verified: 2025-09

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)