Department of Geriatrics, Affiliated Hospital of Nanjing University of Chinese Medicine, 155 Hanzhongmen Road, Nanjing, 210001, Jiangsu, China.
Department of General Medicine, Affiliated Anqing First People's Hospital of Anhui Medical University, Anqing, Anhui, China.
BMC Cardiovasc Disord. 2023 Jun 9;23(1):293. doi: 10.1186/s12872-023-03324-6.
In recent years, the incidence of diabetes mellitus has been increasing annually, and cardiovascular complications secondary to diabetes mellitus have become the leading cause of death in diabetic patients. Considering the high incidence of type 2 diabetes (T2DM) combined with cardiovascular disease (CVD), some new hypoglycemic agents with cardiovascular protective effects have attracted extensive attention. However, the specific role of these regimens in ventricular remodeling remains unknown. The purpose of this network meta-analysis was to compare the effects of sodium glucose cotransporter type 2 inhibitor (SGLT-2i), glucagon-like peptide 1 receptor agonist (GLP-1RA) and dipeptidyl peptidase-4 inhibitor (DPP-4i) on ventricular remodeling in patients with T2DM and/or CVD.
Articles published prior to 24 August 2022 were retrieved in four electronic databases: the Cochrane Library, Embase, PubMed, and Web of Science. This meta-analysis included randomized controlled trials (RCTs) and a small number of cohort studies. The differences in mean changes of left ventricular ultrasonic parameters between the treatment and control groups were compared.
A total of 31 RCTs and 4 cohort studies involving 4322 patients were analyzed. GLP-1RA was more significantly associated with improvement in left ventricular end-systolic diameter (LVESD) [MD = -0.38 mm, 95% CI (-0.66, -0.10)] and LV mass index (LVMI) [MD = -1.07 g/m, 95% CI (-1.71, -0.42)], but significantly decreased e' [MD = -0.43 cm/s 95% CI (-0.81, -0.04)]. DPP-4i was more strongly associated with improvement in e' [MD = 3.82 cm/s, 95% CI (2.92,4.7)] and E/e'[MD = -5.97 95% CI (-10.35, -1.59)], but significantly inhibited LV ejection fraction (LVEF) [MD = -0.89% 95% CI (-1.76, -0.03)]. SGLT-2i significantly improved LVMI [MD = -0.28 g/m, 95% CI (-0.43, -0.12)] and LV end-diastolic diameter (LVEDD) [MD = -0.72 ml, 95% CI (-1.30, -0.14)] in the overall population, as well as E/e' and SBP in T2DM patients combined with CVD, without showing any negative effect on left ventricular function.
The results of the network meta-analysis provided high certainty to suggest that SGLT-2i may be more effective in cardiac remodeling compared to GLP-1RA and DPP-4i. While GLP-1RA and DPP-4i may have a tendency to improve cardiac systolic and diastolic function respectively. SGLT-2i is the most recommended drug for reversing ventricular remodeling in this meta-analysis.
近年来，糖尿病的发病率逐年上升，糖尿病患者继发的心血管并发症已成为其主要致死原因。鉴于 2 型糖尿病（T2DM）合并心血管疾病（CVD）的发病率较高，一些具有心血管保护作用的新型降糖药物引起了广泛关注。然而，这些方案在心室重构中的具体作用仍不清楚。本网状荟萃分析旨在比较钠-葡萄糖共转运蛋白 2 抑制剂（SGLT-2i）、胰高血糖素样肽 1 受体激动剂（GLP-1RA）和二肽基肽酶-4 抑制剂（DPP-4i）对 T2DM 和/或 CVD 患者心室重构的影响。
在 Cochrane 图书馆、Embase、PubMed 和 Web of Science 这四个电子数据库中检索了截至 2022 年 8 月 24 日之前发表的文章。该荟萃分析纳入了随机对照试验（RCT）和少量队列研究。比较了治疗组和对照组之间左心室超声参数平均变化的差异。
共分析了 31 项 RCT 和 4 项队列研究，涉及 4322 名患者。GLP-1RA 与左心室收缩末期直径（LVESD）[MD = -0.38mm，95%CI（-0.66，-0.10）]和左心室质量指数（LVMI）[MD = -1.07g/m，95%CI（-1.71，-0.42）]的改善相关性更强，但明显降低了 e'[MD = -0.43cm/s，95%CI（-0.81，-0.04）]。DPP-4i 与 e'[MD = 3.82cm/s，95%CI（2.92，4.7）]和 E/e'[MD = -5.97，95%CI（-10.35，-1.59）]的改善相关性更强，但明显抑制了左心室射血分数（LVEF）[MD = -0.89%，95%CI（-1.76，-0.03）]。SGLT-2i 显著改善了整体人群的 LVMI[MD = -0.28g/m，95%CI（-0.43，-0.12）]和 LV 舒张末期直径（LVEDD）[MD = -0.72ml，95%CI（-1.30，-0.14）]，以及 T2DM 合并 CVD 患者的 E/e'和 SBP，对左心室功能没有任何负面影响。
网状荟萃分析的结果提供了较高的证据质量，提示 SGLT-2i 可能比 GLP-1RA 和 DPP-4i 更有效逆转心室重构。虽然 GLP-1RA 和 DPP-4i 可能分别有改善心脏收缩和舒张功能的趋势，但 SGLT-2i 是本荟萃分析中最推荐用于逆转心室重构的药物。
