Qiu Mei, Ding Liang-Liang, Zhang Miao, Lin Jin-Hao, Wei Xu-Bin, Huang Hua
Department of General Medicine, Shenzhen Longhua District Central Hospital, Shenzhen, 518110, China.
Department of Endocrinology, First Affiliated Hospital of Yangtze University, Jingzhou, 434000, China.
Diabetes Ther. 2020 Oct;11(10):2429-2440. doi: 10.1007/s13300-020-00912-z. Epub 2020 Aug 27.
The impact of reduction of systolic blood pressure or body weight on reduction of cardiovascular events during the treatment with glucagon-like peptide 1 receptor agonists (GLP-1RAs) or sodium-glucose cotransporter 2 inhibitors (SGLT2is) for type 2 diabetes is unclear.
We searched Embase and PubMed. We performed meta-analysis using hazard ratio (HR) and 95% confidence interval (CI) as effect size stratified by drug class on six endpoints of interest, which were major adverse cardiovascular events (MACE), hospitalization for heart failure (HHF), cardiovascular death (CVD), myocardial infarction (MI), stroke, and all-cause death (ACD). We performed meta-regression to assess the difference between GLP-1RAs and SGLT2is, and the impact of reduction of systolic blood pressure or body weight on reduction of cardiovascular events.
We included 11 randomized trials. Compared with placebo, SGLT2is reduced HHF by 32% (HR 0.68, 95% CI 0.60-0.76) whereas GLP-1RAs reduced HHF by only 9% (HR 0.91, 95% CI 0.83-0.99). The benefit from SGLT2is on HHF was significantly greater than that from GLP-1RAs (P = 0.004). GLP-1RAs reduced stroke by 16% (HR 0.84, 95% CI 0.76-0.93) whereas SGLT2is did not reduce stroke (HR 0.96, 95% CI 0.82-1.12). GLP-1RAs and SGLT2is similarly reduced MACE by 12%, CVD by 15%, MI by 9%, and ACD by 13%. The effects of systolic blood pressure reduction and body weight reduction on the logarithms of HRs of GLP-1RAs or SGLT2is vs. placebo as for reducing six endpoints of interest were not statistically significant (β ranged from - 0.145 to 0.269, and P ranged from 0.211 to 0.941).
GLP-1RAs and SGLT2is lead to similar benefits on MACE, CVD, MI, and ACD in adults with type 2 diabetes. The benefit from SGLT2is on HHF is greater than that from GLP-1RAs, while GLP-1RAs vs. placebo significantly reduce stroke whereas SGLT2is do not. The two drug classes reduce cardiovascular events independent of reductions of systolic blood pressure and body weight.
在使用胰高血糖素样肽-1受体激动剂（GLP-1RAs）或钠-葡萄糖协同转运蛋白2抑制剂（SGLT2is）治疗2型糖尿病期间，收缩压降低或体重减轻对心血管事件减少的影响尚不清楚。
我们检索了Embase和PubMed数据库。我们使用风险比（HR）和95%置信区间（CI）作为效应量，按药物类别对六个感兴趣的终点进行荟萃分析，这六个终点分别是主要不良心血管事件（MACE）、因心力衰竭住院（HHF）、心血管死亡（CVD）、心肌梗死（MI）、中风和全因死亡（ACD）。我们进行了荟萃回归分析，以评估GLP-1RAs和SGLT2is之间的差异，以及收缩压降低或体重减轻对心血管事件减少的影响。
我们纳入了11项随机试验。与安慰剂相比，SGLT2is使HHF降低了32%（HR 0.68，95%CI 0.60-0.76），而GLP-1RAs仅使HHF降低了9%（HR 0.91，95%CI 0.83-0.99）。SGLT2is对HHF的益处显著大于GLP-1RAs（P = 0.004）。GLP-1RAs使中风降低了16%（HR 0.84，95%CI 0.76-0.93），而SGLT2is未降低中风（HR 0.96，95%CI 0.82-1.12）。GLP-1RAs和SGLT2is使MACE、CVD、MI和ACD同样降低了12%、15%、9%和13%。收缩压降低和体重减轻对GLP-1RAs或SGLT2is与安慰剂相比降低六个感兴趣终点的HR对数的影响无统计学意义（β范围为-0.145至0.269，P范围为0.211至0.941）。
GLP-1RAs和SGLT2is对2型糖尿病成人患者的MACE、CVD、MI和ACD产生相似的益处。SGLT2is对HHF的益处大于GLP-1RAs，而GLP-1RAs与安慰剂相比显著降低中风，而SGLT2is则不然。这两类药物降低心血管事件与收缩压和体重的降低无关。
