Aerospace Center Hospital, Beijing, China; and Peking University Aerospace School of Clinical Medicine, Beijing, China.
Aerospace Center Hospital, Beijing, China; and Peking University Aerospace School of Clinical Medicine, Beijing, China.
Heart Rhythm. 2021 Jul;18(7):1090-1096. doi: 10.1016/j.hrthm.2021.03.007. Epub 2021 Mar 5.
Diabetes is associated with the progression of atrial fibrillation (AF) and atrial flutter (AFL). However, whether glucose-lowering agents could reduce AF/AFL remains unclear. We hypothesized that different glucose-lowering agents exhibit different characteristic effects on the risk of AF/AFL.
The goals of this study were to evaluate the effect of different glucose-lowering agents and identify the optimal treatment that can reduce AF/AFL events in patients with diabetes.
We searched PubMed, Embase, and the Cochrane Library from their inception to September 30, 2020. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used in this network meta-analysis. The primary end point of our study was AF or AFL. Only studies that reported AF/AFL as clinical end points with a follow-up period of at least 12 months were included. The results from trials were presented as odds ratios (ORs) with 95% confidence intervals (CIs). The results were pooled using a Bayesian random-effects model.
Five eligible studies (9 glucose-lowering agents, including thiazolidinedione, metformin, sulfonylurea, insulin, dipeptidyl peptidase-4 inhibitor, glucagon-like peptide-1 receptor agonist [GLP-1RA], sodium-glucose cotransporter 2 inhibitor, alpha-glucosidase inhibitor, and non-sulfonylurea) consisting of 263,583 patients with type 2 diabetes mellitus were included. Based on the pooled results, GLP-1RA significantly reduced AF/AFL events compared with metformin (OR 0.17; 95% CI 0.04-0.61), sulfonylurea (OR 0.23; 95% CI 0.07-0.73), insulin (OR 0.20; 95% CI 0.07-0.86), and non-sulfonylurea (OR 0.18; 95% CI 0.04-0.66).
Compared with other glucose-lowering agents, GLP-1RA could reduce the risk of AF/AFL in patients with diabetes.
糖尿病与心房颤动（AF）和心房扑动（AFL）的进展有关。然而，降低血糖的药物是否能降低 AF/AFL 仍不清楚。我们假设不同的降糖药物对 AF/AFL 的风险有不同的特征影响。
本研究的目的是评估不同降糖药物的作用，并确定能降低糖尿病患者 AF/AFL 事件的最佳治疗方法。
我们检索了 PubMed、Embase 和 Cochrane 图书馆，检索时间从成立到 2020 年 9 月 30 日。本网络荟萃分析采用了系统评价和荟萃分析的首选报告项目。我们研究的主要终点是 AF 或 AFL。只有报告 AF/AFL 作为临床终点且随访时间至少 12 个月的研究才被纳入。试验结果以比值比（ORs）及其 95%置信区间（CIs）表示。使用贝叶斯随机效应模型对结果进行汇总。
纳入了 5 项符合条件的研究（9 种降糖药物，包括噻唑烷二酮、二甲双胍、磺酰脲类、胰岛素、二肽基肽酶-4 抑制剂、胰高血糖素样肽-1 受体激动剂[GLP-1RA]、钠-葡萄糖共转运蛋白 2 抑制剂、α-葡萄糖苷酶抑制剂和非磺酰脲类），共包括 263583 例 2 型糖尿病患者。根据汇总结果，GLP-1RA 与二甲双胍（OR 0.17；95%CI 0.04-0.61）、磺酰脲类（OR 0.23；95%CI 0.07-0.73）、胰岛素（OR 0.20；95%CI 0.07-0.86）和非磺酰脲类（OR 0.18；95%CI 0.04-0.66）相比，能显著降低 AF/AFL 事件的发生风险。
与其他降糖药物相比，GLP-1RA 可降低糖尿病患者发生 AF/AFL 的风险。
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