Diabetology, Careggi Hospital and University of Florence, Italy.
Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology of the Sapienza University of Rome, Rome, Italy.
Nutr Metab Cardiovasc Dis. 2020 Jun 25;30(7):1106-1114. doi: 10.1016/j.numecd.2020.03.013. Epub 2020 Mar 25.
Glucagon-like Peptide 1 Receptor Agonists (GLP1-RA) has been associated with a reduction of major cardiovascular events (MACE) and mortality on the basis of the results of cardiovascular outcome trials (CVOT). Several meta-analyses on this issue have been recently published; however, they were all restricted to CVOT, with the exclusion of all studies designed for other endpoints; moreover, other cardiovascular endpoints, such as atrial fibrillation and heart failure have not been fully explored.
A Medline search for GLP-1 receptor agonists (exenatide, liraglutide, lixisenatide, albiglutide, dulaglutide, or semaglutide) was performed, collecting all randomized clinical trials with a duration ≥52 weeks, enrolling patients with type 2 diabetes, and comparing a GLP-1 receptor agonist with placebo or any other non-GLP-1 receptor agonist drug. We included 43 trials, enrolling 63,134 patients. A significant reduction of MACE (MH-OR 0.87 [0.83, 0.92]), all-cause mortality (MH-OR 0.89 [0.83, 0.96]), and a nonstatistical trend toward reduction of heart failure (MH-OR 0.93 [0.85, 1.01]) was observed - GLP1-RA did not increase the risk of atrial fibrillation (MH-OR 0.94 [0.84, 1.04]).
The present meta-analysis confirms the favorable effects of glucagon-like peptide-1 receptor agonists on major cardiovascular events, cardiovascular and all-cause mortality, stroke, and possibly myocardial infarction. Conversely, the effects on heart failure remain uncertain. Available data on atrial fibrillation seems to exclude any major safety issues in this respect.
REGISTRATION NUMBER (PROSPERO): CRD42018115577.
基于心血管结局试验（CVOT）的结果，胰高血糖素样肽 1 受体激动剂（GLP1-RA）与主要心血管事件（MACE）和死亡率的降低相关。最近发表了几项关于这个问题的荟萃分析；然而，它们都仅限于 CVOT，排除了所有设计用于其他终点的研究；此外，其他心血管终点，如心房颤动和心力衰竭，尚未得到充分探讨。
对 GLP-1 受体激动剂（艾塞那肽、利拉鲁肽、利西那肽、阿必鲁肽、度拉糖肽或司美格鲁肽）进行了 Medline 检索，收集了所有持续时间≥52 周的随机临床试验，纳入了 2 型糖尿病患者，并比较了 GLP-1 受体激动剂与安慰剂或任何其他非 GLP-1 受体激动剂药物。我们纳入了 43 项试验，共纳入 63134 名患者。观察到 MACE（MH-OR 0.87 [0.83, 0.92]）、全因死亡率（MH-OR 0.89 [0.83, 0.96]）和心力衰竭的非统计学趋势降低（MH-OR 0.93 [0.85, 1.01]）-GLP1-RA 并未增加心房颤动的风险（MH-OR 0.94 [0.84, 1.04]）。
本荟萃分析证实了胰高血糖素样肽-1 受体激动剂对主要心血管事件、心血管和全因死亡率、卒中和可能心肌梗死的有利影响。相反，对心力衰竭的影响仍不确定。关于心房颤动的现有数据似乎排除了这方面的任何重大安全问题。
注册号（PROSPERO）：CRD42018115577。
