Council of Epidemiology and Cardiovascular Prevention, Argentine Society of Cardiology, Azcuenaga 980, Buenos Aires, Argentina.
Cardiology Department, Sanatorio Finochietto, Av. Córdoba 2678, Buenos Aires, Argentina.
High Blood Press Cardiovasc Prev. 2021 Nov;28(6):605-612. doi: 10.1007/s40292-021-00479-1. Epub 2021 Oct 27.
Sodium Glucose Co-transporter 2 inhibitors and glucagon-like peptide 1 receptor agonists (GLP-1RAs) were associated with a reduction in cardiovascular disease events in cardiovascular outcomes trials (CVOTs) in type 2 diabetes. Most of the patients included in these trials received metformin as background therapy.
To evaluate the effect of glucagon-like peptide 1 receptor agonists on major cardiovascular events (MACE) and mortality in metformin-naïve patients with type 2 diabetes.
A systematic review and meta-analysis of randomized controlled clinical trials of GLP-1RAs on type 2 diabetes population was performed, after searching the PubMed/MEDLINE, Embase, Scielo, Google Scholar and Cochrane Controlled Trials databases. The primary endpoint was MACE. The secondary endpoints were cardiovascular death and all-cause mortality. A meta-analysis of time-to-event outcomes was performed. This meta-analysis was registered in PROSPERO (CRD42021260040) RESULTS: Seven trials, including 11510 patients, were identified and considered eligible for the analyses. GLP-1RAs were associated with a significant reduction in MACE incidence (HR: 0.86, 95% confidence interval: 0.79-0.94; I: 0%). The secondary endpoints analysis showed a non-significant reduction in all-cause mortality (HR: 0.86, 95% confidence interval: 0.73-1.00 I: 0%) and cardiovascular mortality (HR: 0.81, 95% confidence interval: 0.63-1.05; I: 0%).
In this meta-analysis, GLP-1RAs reduced the incidence of MACE in patients with type 2 diabetes without metformin at baseline, without significant reduction in all-cause mortality and cardiovascular mortality. These results support the fact that when a GLP-1RAs is administered, the benefit on cardiovascular outcomes is independent of the use of metformin.
钠-葡萄糖共转运蛋白 2 抑制剂（SGLT2i）和胰高血糖素样肽 1 受体激动剂（GLP-1RA）与心血管结局试验（CVOT）中 2 型糖尿病患者的心血管疾病事件减少相关。这些试验中大多数患者接受二甲双胍作为背景治疗。
评估胰高血糖素样肽 1 受体激动剂（GLP-1RA）对二甲双胍初治的 2 型糖尿病患者主要心血管事件（MACE）和死亡率的影响。
对 GLP-1RA 在 2 型糖尿病人群中的随机对照临床试验进行系统评价和荟萃分析，检索 PubMed/MEDLINE、Embase、Scielo、Google Scholar 和 Cochrane 对照试验数据库。主要终点是 MACE。次要终点是心血管死亡和全因死亡率。对时间事件结局进行荟萃分析。本荟萃分析已在 PROSPERO（CRD42021260040）注册。
共纳入 7 项试验，包括 11510 例患者，认为符合分析条件。GLP-1RA 可显著降低 MACE 发生率（HR：0.86，95%置信区间：0.79-0.94；I²：0%）。次要终点分析显示全因死亡率（HR：0.86，95%置信区间：0.73-1.00；I²：0%）和心血管死亡率（HR：0.81，95%置信区间：0.63-1.05；I²：0%）无显著降低。
在这项荟萃分析中，GLP-1RA 降低了基线时无二甲双胍治疗的 2 型糖尿病患者的 MACE 发生率，全因死亡率和心血管死亡率无显著降低。这些结果支持以下事实，即当给予 GLP-1RA 时，心血管结局的获益独立于二甲双胍的使用。
