Division of Endocrinology and Metabolic Diseases, Department of Advanced Medical and Surgical Sciences, Università della Campania L. Vanvitelli, Naples, Italy.
Medical Statistics Unit, Università della Campania L. Vanvitelli, Naples, Italy.
Endocrine. 2019 Jul;65(1):15-24. doi: 10.1007/s12020-019-01931-y. Epub 2019 Apr 26.
We performed a meta-analysis of randomized controlled trials (RCTs) that evaluated the effect of dipeptidyl peptidase-4 inhibitors (DPP-4i), glucagon-like peptide-1 receptor agonists (GLP-1 RAs), and sodium glucose co-transporter-2 inhibitors (SGLT-2i) on heart failure (HF) risk in patients with type 2 diabetes (T2D).
The electronic search was carried out until 10 November 2018. RCTs were included if they compared add-on therapy with any DPP-4i, GLP-1 RAs, or SGLT-2i with placebo, and included in the outcome hospitalization for HF, and other outcomes required for cardiovascular safety studies. Risk of HF was the primary outcome for this meta-analysis. We used a random-effect model to calculate hazard ratio (HR) and 95% CI. Twelve trials were identified, involving 120,765 patients. Compared with placebo, HF risk showed a non-significant 10% reduction with the newer anti-hyperglycemic drugs (HR = 0.90, 0.80-1.01); use of DPP-4i and GLP-1 RAs was associated with nonsignificant modifications of the HF risk (+5% and -9%, respectively), while the use of SGLT-2i was associated with a significant 31% reduction of the HF risk (HR = 0.69, 0.61-0.79, P < 0.001), with no heterogeneity (I = 0%, P = 0.741), suggesting a class effect. The meta-regression analysis of all 12 trials showed no association of reductions of hemoglobin A1C with HF risk.
In T2D, SGLT-2i can reduce the risk of HF that is unrelated to improved glycemic control; DPP-4i and GLP-1 RAs behave as neutral.
我们对评估二肽基肽酶-4 抑制剂（DPP-4i）、胰高血糖素样肽-1 受体激动剂（GLP-1 RAs）和钠-葡萄糖共转运蛋白-2 抑制剂（SGLT-2i）对 2 型糖尿病（T2D）患者心力衰竭（HF）风险的影响进行了随机对照试验（RCT）的荟萃分析。
电子检索截至 2018 年 11 月 10 日。如果比较任何 DPP-4i、GLP-1 RAs 或 SGLT-2i 的附加治疗与安慰剂，并包括心力衰竭住院等心血管安全性研究所需的其他结局，则纳入 RCT。HF 风险是本荟萃分析的主要结局。我们使用随机效应模型计算危险比（HR）和 95%CI。确定了 12 项试验，涉及 120765 名患者。与安慰剂相比，新型抗高血糖药物使 HF 风险降低了 10%，但无统计学意义（HR=0.90，0.80-1.01）；使用 DPP-4i 和 GLP-1 RAs 分别使 HF 风险增加了 5%和减少了 9%，但无统计学意义，而使用 SGLT-2i 使 HF 风险显著降低了 31%（HR=0.69，0.61-0.79，P<0.001），无异质性（I=0%，P=0.741），提示存在类效应。对所有 12 项试验的荟萃回归分析显示，糖化血红蛋白降低与 HF 风险无关。
在 T2D 中，SGLT-2i 可降低 HF 风险，与改善血糖控制无关；DPP-4i 和 GLP-1 RAs 则表现为中性。
