Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang District, Beijing, 100020, China.
Cardiovasc Diabetol. 2020 Jan 22;19(1):10. doi: 10.1186/s12933-020-0987-x.
Although a variety of antidiabetic drugs have significant protective action on the cardiovascular system, it is still unclear which antidiabetic drugs can improve ventricular remodeling and fundamentally delay the process of heart failure. The purpose of this network meta-analysis is to compare the efficacy of sodium glucose cotransporter type 2 (SGLT-2) inhibitors, dipeptidyl peptidase-4 (DPP-4) inhibitors, glucagon-like peptide-1 (GLP-1) agonists, metformin (MET), sulfonylurea (SU) and thiazolidinediones (TZDs) in improving left ventricular (LV) remodeling in patients with type 2 diabetes (T2DM) and/or cardiovascular disease (CVD).
We searched articles published before October 18, 2019, regardless of language or data, in 4 electronic databases: PubMed, EMBASE, Cochrane Library and Web of Science. We included randomized controlled trials in this network meta-analysis, as well as a small number of cohort studies. The differences in the mean changes in left ventricular echocardiographic parameters between the treatment group and control group were evaluated.
The difference in the mean change in LV ejection fraction (LVEF) between GLP-1 agonists and placebo in treatment effect was greater than zero (MD = 2.04% [0.64%, 3.43%]); similar results were observed for the difference in the mean change in LV end-diastolic diameter (LVEDD) between SGLT-2 inhibitors and placebo (MD = - 3.3 mm [5.31, - 5.29]), the difference in the mean change in LV end-systolic volume (LVESV) between GLP-1 agonists and placebo (MD = - 4.39 ml [- 8.09, - 0.7]); the difference in the mean change in E/e' between GLP-1 agonists and placebo (MD = - 1.05[- 1.78, - 0.32]); and the difference in the mean change in E/e' between SGLT-2 inhibitors and placebo (MD = - 1.91[- 3.39, - 0.43]).
GLP-1 agonists are more significantly associated with improved LVEF, LVESV and E/e', SGLT-2 inhibitors are more significantly associated with improved LVEDD and E/e', and DPP-4 inhibitors are more strongly associated with a negative impact on LV end-diastolic volume (LVEDV) than are placebos. SGLT-2 inhibitors are superior to other drugs in pairwise comparisons.
尽管各种抗糖尿病药物对心血管系统具有显著的保护作用，但仍不清楚哪种抗糖尿病药物可以改善心室重构并从根本上延缓心力衰竭进程。本网络荟萃分析的目的是比较钠-葡萄糖共转运蛋白 2（SGLT-2）抑制剂、二肽基肽酶-4（DPP-4）抑制剂、胰高血糖素样肽-1（GLP-1）激动剂、二甲双胍（MET）、磺酰脲类（SU）和噻唑烷二酮类（TZDs）在改善 2 型糖尿病（T2DM）和/或心血管疾病（CVD）患者左心室（LV）重构方面的疗效。
我们在 4 个电子数据库（PubMed、EMBASE、Cochrane 图书馆和 Web of Science）中检索了截至 2019 年 10 月 18 日之前发表的文章，无论语言或数据如何，均纳入本网络荟萃分析。我们还纳入了随机对照试验和少量队列研究。评估治疗组和对照组之间左心室超声心动图参数的平均变化差异。
GLP-1 激动剂与安慰剂相比，左心室射血分数（LVEF）的平均变化差异大于零（MD=2.04%[0.64%，3.43%]）；SGLT-2 抑制剂与安慰剂相比，LV 舒张末期直径（LVEDD）的平均变化差异（MD=-3.3mm[5.31，-5.29]）、GLP-1 激动剂与安慰剂相比，LV 收缩末期容积（LVESV）的平均变化差异（MD=-4.39ml[-8.09，-0.7]）、GLP-1 激动剂与安慰剂相比，E/e'的平均变化差异（MD=-1.05[-1.78，-0.32]）以及 SGLT-2 抑制剂与安慰剂相比，E/e'的平均变化差异（MD=-1.91[-3.39，-0.43]）均大于零。
GLP-1 激动剂与 LVEF、LVESV 和 E/e'的改善相关性更显著，SGLT-2 抑制剂与 LVEDD 和 E/e'的改善相关性更显著，DPP-4 抑制剂对 LV 舒张末期容积（LVEDV）的负面影响较安慰剂更显著。SGLT-2 抑制剂在两两比较中优于其他药物。
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