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385 doi: (Published 25 April 2024) Cite this as: BMJ 2024;385:e078242 Nikita Simms-Williams, research associate1, Nir Treves, doctoral student2, Hui Yin, statistician1, Sally Lu, research associate3, Oriana Yu, endocrinologist and associate professor3 4, Richeek Pradhan, postdoctoral fellow5, Christel Renoux, neurologist and associate professor3 6 7, Samy Suissa, professor3 6, Laurent Azoulay, professor3 6 8 1 Institute of Applied Health Research College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK 2 Department of Clinical Pharmacy, Hebrew University of Jerusalem, Jerusalem, Israel 3 Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Canada 4 Division of Endocrinology, Jewish General Hospital, Montreal, QC, Canada 5 Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA 6 Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada 7 Departments of Neurology and Neurosurgery, Jewish General Hospital, Montreal, QC, Canada 8 Gerald Bronfman Department of Oncology, McGill University, Montreal, QC, Canada Correspondence to: L Azoulay laurent mcgill.ca (or @ProfLAzoulay on X/Twitter) Accepted 29 February 2024 Abstract Objective To determine whether the combined use of glucagon-like peptide-1 (GLP-1) receptor agonists and sodium-glucose cotransporter-2 (SGLT-2) inhibitors is associated with a decreased risk of major adverse cardiovascular events and serious renal events compared with either drug class alone among patients with type 2 diabetes, and to assess the effect of the combination on the individual components of major adverse cardiovascular events, heart failure, and all cause mortality