GLP-1 受体激动剂和 SGLT2 抑制剂治疗 2 型糖尿病老年患者：系统评价和荟萃分析。
GLP-1 receptor agonists and SGLT2 inhibitors for older people with type 2 diabetes: A systematic review and meta-analysis.
机构信息
Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece; Diabetes Centre, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece; Harris Manchester College, University of Oxford, Oxford, United Kingdom.
出版信息
Diabetes Res Clin Pract. 2021 Apr;174:108737. doi: 10.1016/j.diabres.2021.108737. Epub 2021 Mar 8.
AIMS
To assess the cardiovascular effects of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium-glucose co-transporter-2 (SGLT2) inhibitors in older people with type 2 diabetes.
METHODS
PubMed, Embase, and Cochrane library were searched up to November 2020 for cardiovascular outcomes trials with GLP-1 RAs or SGLT2 inhibitors that reported results for older patients with type 2 diabetes. Random-effects meta-analyses were conducted for different age subgroup categories.
RESULTS
A total of 11 studies (93,502 patients) were included. Consistent with their effect in the overall population, in patients ≥65 years, GLP-1 RAs reduced major adverse cardiovascular events (MACE) (hazard ratio [HR], 0.86; 95% confidence interval [CI], 0.80-0.92), cardiovascular death, stroke, and myocardial infarction. In the same age subgroup, SGLT2 inhibitors reduced MACE (HR, 0.90; 95% CI, 0.83-0.98) but had a neutral effect on its components. They also reduced heart failure hospitalization (HR, 0.62; 95% CI, 0.51-0.76), an effect that was not evident in patients <65 years, and the composite renal endpoint (HR, 0.57; 95% CI, 0.43-0.77). Meta-analyses for patients ≥75 years yielded similar results.
CONCLUSIONS
In older adults with diabetes, GLP-1 RAs reduced MACE and its components. SGLT2 inhibitors reduced MACE, and heart failure and renal outcomes.
目的
评估胰高血糖素样肽-1 受体激动剂（GLP-1 RAs）和钠-葡萄糖共转运蛋白 2（SGLT2）抑制剂对 2 型糖尿病老年患者的心血管影响。
方法
检索 PubMed、Embase 和 Cochrane 图书馆截至 2020 年 11 月的心血管结局试验，纳入 GLP-1 RAs 或 SGLT2 抑制剂治疗 2 型糖尿病老年患者的研究。对不同年龄亚组进行了随机效应荟萃分析。
结果
共纳入 11 项研究（93502 例患者）。与在总体人群中的作用一致，在≥65 岁的患者中，GLP-1 RAs 降低了主要不良心血管事件（MACE）（风险比 [HR]，0.86；95%置信区间 [CI]，0.80-0.92）、心血管死亡、卒中和心肌梗死。在同一年龄亚组中，SGLT2 抑制剂降低了 MACE（HR，0.90；95%CI，0.83-0.98），但其各组成部分无显著影响。它们还降低了心力衰竭住院率（HR，0.62；95%CI，0.51-0.76），这一作用在<65 岁的患者中并不明显，以及复合肾脏终点事件（HR，0.57；95%CI，0.43-0.77）。对≥75 岁患者的荟萃分析得出了相似的结果。
结论
在老年糖尿病患者中，GLP-1 RAs 降低了 MACE 及其组成部分。SGLT2 抑制剂降低了 MACE、心力衰竭和肾脏结局。
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