MSR92 Racial and Smoking Status Disparities in Mediation Effects on Liraglutide-Associated Cardiovascular Outcomes: A Dynamic Path Analysis Using Leader Trial Data

Abstract

Mediation analyses are useful to disentangle possible causal pathways from an exposure/treatment to its clinically relevant outcomes. Mediation effects are commonly presented in changes in hazard ratios obtained from Cox proportional hazard model analyses, yet the assumption of proportionality is however violated with a post-exposure mediator added into the analysis. Dynamic path analysis evolved more recently where the proportionality is not required and all time-varying mediators can be simultaneously modeled, thereby reflecting the complexity of mediators in causal pathways. We sought to apply dynamic path analyses for assessing the heterogeneity of mediation effects on liraglutide-associated major adverse cardiovascular event (MACE) outcome by racial and smoking status of patients.