Huixing Liu, Di Fu, Daoquan Peng
Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
Clin Ther. 2023 Jan;45(1):17-30. doi: 10.1016/j.clinthera.2022.12.006. Epub 2023 Jan 3.
Whether an antidiabetic drug, glucagon-like peptide-1 receptor agonist (GLP-1RA), could improve the prognosis of heart failure and cardiac function remains controversial. We conducted a systematic review and meta-analysis of randomized controlled trials to explore the influence of GLP-1RAs on heart failure in patients regardless of diabetes diagnosis.
Literature in English from the PubMed, EMBASE, and Cochrane Library databases was searched from inception to July 2022. The study aim was to identify published, randomized, placebo-controlled trials testing GLP-1RAs in patients with or without diabetes. Outcomes were heart failure hospitalization, cardiac function, and structure measures.
Twenty-two randomized controlled trials involving 61,412 patients are included in the meta-analysis. Overall, compared with the placebo group, GLP-1RA treatment could not significantly decrease heart failure hospitalization in patients with a history of heart failure (hazard ratio [HR], 1.07; 95% CI, 0.91 to 1.25; P = 0.422). Six-minute walking test distances (WMD, 19.08 m; 95% CI, 4.81 to 33.36; P = 0.01), E-wave (SMD, -0.40; 95% CI, -0.60 to -0.20; P < 0.001), early diastolic to late diastolic velocities ratio (WMD, -0.10; 95% CI, -0.18 to -0.02; P = 0.01), mitral inflow E velocity to tissue Doppler e' ratio (WMD, -0.97; 95% CI, -1.54 to -0.41; P < 0.001), and E-wave deceleration time (WMD, -9.96 milliseconds; 95% CI, -18.52 to -1.41; P = 0.02) increased significantly after administration of GLP-1RAs. However, GLP-1RAs do not significantly influence N-terminal pro-B-type natriuretic peptide levels (WMD, -20.02 pg/mL; 95% CI, -53.12 to 13.08; P = 0.24), Minnesota Living with Heart Failure Questionnaire quality of life scores (WMD, -1.08; 95% CI, -3.99 to 1.84; P = 0.47), or left ventricular ejection fractions (WMD, -0.37%; 95% CI, -1.19 to 0.46; P = 0.38).
GLP-1RAs did not reduce heart failure readmissions in patients with a history of heart failure and elevated N-terminal pro-B-type natriuretic peptide levels. Thus, the prognosis of heart failure was not improved, although GLP-1RAs did significantly improve left ventricular diastolic function in patients. PROSPERO identifier: CRD42021226231.
抗糖尿病药物胰高血糖素样肽-1受体激动剂（GLP-1RA）是否能改善心力衰竭的预后和心脏功能仍存在争议。我们进行了一项随机对照试验的系统评价和荟萃分析，以探讨GLP-1RA对心力衰竭患者（无论是否诊断为糖尿病）的影响。
检索了PubMed、EMBASE和Cochrane图书馆数据库中从创建到2022年7月的英文文献。研究目的是确定已发表的、随机的、安慰剂对照试验，这些试验在有或没有糖尿病的患者中测试GLP-1RA。结局指标为心力衰竭住院、心脏功能和结构指标。
荟萃分析纳入了22项涉及61412例患者的随机对照试验。总体而言，与安慰剂组相比，GLP-1RA治疗不能显著降低有心力衰竭病史患者的心力衰竭住院率（风险比[HR]，1.07；95%置信区间[CI]，0.91至1.25；P = 0.422）。给予GLP-1RA后，六分钟步行试验距离（加权均数差[WMD]，19.08 m；95% CI，4.8l至33.36；P = 0.01）、E波（标准化均数差[SMD]，-0.40；95% CI，-0.60至-0.20；P < 0.001）、舒张早期与舒张晚期速度比值（WMD，-0.10；95% CI，-0.18至-0.02；P = 0.01）、二尖瓣流入E速度与组织多普勒e'比值（WMD，-0.97；95% CI，-1.54至-0.41；P < 0.001）和E波减速时间（WMD，-9.96毫秒；95% CI，-18.52至-1.41；P = 0.02）显著增加。然而，GLP-1RA对N末端B型脑钠肽前体水平（WMD，-20.02 pg/mL；95% CI，-53.12至13.08；P = 0.24）、明尼苏达心力衰竭生活质量问卷评分（WMD，-1.08；95% CI，-3.99至1.84；P = 0.47）或左心室射血分数（WMD，-0.37%；95% CI，-1.19至0.46；P = 0.38）无显著影响。
GLP-1RA不能降低有心力衰竭病史且N末端B型脑钠肽前体水平升高患者的心力衰竭再入院率。因此，尽管GLP-1RA确实能显著改善患者的左心室舒张功能，但心力衰竭的预后并未得到改善。国际前瞻性系统评价注册库标识符：CRD42021226231。
