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In the GLP-1 RA group, 33 participants were subsequently newly diagnosed with heart failure, compared with 15 in the SGLT2i group (RR 0.44 [95% CI 0.23, 0.83] p =0.0092)

Although the direction of association was consistent and statistical heterogeneity was low, serious concerns about indirectness arose because NAION diagnoses were based on administrative coding without ophthalmologic confirmation, and key risk modifiers (optic disc anatomy, rate of glycemic reduction) were not accounted for

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Direct metabolic improvement independent of weight loss