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Characteristics of the patient cohort are listed in Table 3

The medication can be part of that process

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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

The freezing process creates ice crystals that can tear the peptide molecules apart