Guo Xueyuan, Sang Caihua, Tang Ribo, Jiang Chenxi, Li Songnan, Liu Nian, Long Deyong, Du Xin, Dong Jianzeng, Ma Changsheng
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China.
Diabetes Obes Metab. 2023 Apr;25 Suppl 1:53-63. doi: 10.1111/dom.15043. Epub 2023 Mar 31.
To perform a meta-analysis to assess the effects of glucagon-like peptide-1 receptor agonists (GLP-1RAs) on major coronary events, including myocardial infarction (MI), unstable angina and coronary revascularization, in patients with type 2 diabetes mellitus (T2DM).
We systematically searched the PubMed, CENTRAL, EMBASE and clinicaltrial.gov databases to seek eligible studies with a cardiovascular endpoint comparing GLP-1RAs with a placebo in T2DM patients. Odds ratio (ORs) and 95% confidence intervals (CIs) were calculated for the outcomes.
Nine studies, with a total of 64 236 patients, were included. GLP-1RA treatment reduced fatal and nonfatal MI by 8% (OR 0.92, 95% CI 0.86-0.99; P = 0.02, I = 39%). The reduction reached 15% in human-based GLP-1RA-treated patients. Similarly, once-weekly GLP-1RA treatment reduced the risk of MI by 13%. In contrast, GLP-1RA treatment did not reduce the risk of hospitalization for unstable angina (OR 1.11, 95% CI 0.97-1.28; P = 0.13, I = 21%). GLP-1RAs exhibited a tendency to lower the risk of coronary revascularization (OR 0.95, 95% CI 0.89-1.02; P = 0.15, I = 22%), but without statistical significance. Human-based GLP-1RAs decreased the risk by 11%.
In high-risk patients with T2DM, GLP-1RAs were associated with a decrease in MI, especially the human-based and once-weekly GLP-1RAs. No benefit was seen for hospitalization for unstable angina or coronary revascularization. Further research is urgently needed to ascertain improvements in coronary events.
进行一项荟萃分析，以评估胰高血糖素样肽-1受体激动剂（GLP-1RAs）对2型糖尿病（T2DM）患者主要冠状动脉事件的影响，包括心肌梗死（MI）、不稳定型心绞痛和冠状动脉血运重建。
我们系统检索了PubMed、CENTRAL、EMBASE和clinicaltrial.gov数据库，以寻找在T2DM患者中比较GLP-1RAs与安慰剂并以心血管终点为指标的合格研究。计算各结局的比值比（OR）和95%置信区间（CI）。
纳入9项研究，共64236例患者。GLP-1RA治疗使致命性和非致命性MI降低8%（OR 0.92，95%CI 0.86 - 0.99；P = 0.02，I² = 39%）。在接受人源化GLP-1RA治疗的患者中，降低幅度达15%。同样，每周一次的GLP-1RA治疗使MI风险降低13%。相比之下，GLP-1RA治疗未降低不稳定型心绞痛住院风险（OR 1.11，95%CI 0.97 - 1.28；P = 0.13，I² = 21%）。GLP-1RAs有降低冠状动脉血运重建风险的趋势（OR 0.95，95%CI 0.89 - 1.02；P = 0.15，I² = 22%），但无统计学意义。人源化GLP-1RAs使风险降低11%。
在T2DM高危患者中，GLP-1RAs与MI减少相关，尤其是人源化和每周一次的GLP-1RAs。在不稳定型心绞痛住院或冠状动脉血运重建方面未见益处。迫切需要进一步研究以确定冠状动脉事件方面的改善情况。
