胰高血糖素样肽-1受体激动剂的血糖控制幅度与体重减轻及动脉粥样硬化性心血管疾病风险之间的关联：糖尿病心血管结局随机试验的系统评价和荟萃分析
Association Between the Magnitude of Glycemic Control and Body Weight Loss With GLP-1 Receptor Agonists and Risk of Atherosclerotic Cardiovascular Disease: A Systematic Review and Meta-analyses of Randomized Diabetes Cardiovascular Outcomes Trials.
作者信息
Gomes Daniel A, Presume João, de Araújo Gonçalves Pedro, Almeida Manuel Sousa, Mendes Miguel, Ferreira Jorge
机构信息
Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Av. Prof. Dr. Reinaldo Dos Santos, Carnaxide, 2790-134, Lisbon, Portugal.
Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal.
出版信息
Cardiovasc Drugs Ther. 2025 Apr;39(2):337-345. doi: 10.1007/s10557-024-07547-3. Epub 2024 Jan 12.
PURPOSE
Reduction of major atherosclerotic cardiovascular events (MACE) has not been consistent among different glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in patients with type 2 diabetes mellitus (T2DM). The aim of this study was to assess the association between the magnitude of glycemic control, body weight loss, and reductions in systolic blood pressure (SBP) and low-density lipoprotein cholesterol (LDL-C) achieved through GLP-1 RA therapy and MACE.
METHODS
Electronic databases (MEDLINE, CENTRAL, SCOPUS) were searched through March 2023. Studies were eligible if they were cardiovascular outcome trials (CVOTs) comparing GLP-1 RAs versus placebo in T2DM patients. The outcome of interest was 3-point MACE - cardiovascular death, myocardial infarction, or stroke. Random-effects meta-regression analyses evaluated the associations between reductions of HbA, body weight, SBP and LDL-C and reduction of MACE.
RESULTS
Overall, 8 CVOTs were included (60079 patients, 30693 with GLP-1 RAs). Reductions of HbA were associated with the reduction of 3P-MACE (Log RR -0.290 [95% CI -0.515;-0.064], p = 0.012), with an estimated RR reduction of 25% for each 1% absolute reduction in HbA levels. Body weight loss was associated with the reduction of 3P-MACE (Log RR -0.068 [95% CI -0.135;-0.001], p = 0.047), with an estimated RR reduction of 7% for each 1 kg reduction in body weight. Reductions of SBP (Log RR -0.058 [95% CI -0.192;0.076], p = 0.396) and LDL-C (Log RR -0.602 [95% CI -4.157;2.953], p = 0.740) were not associated with the reduction of 3P-MACE.
CONCLUSIONS
In T2DM patients, more potent GLP-1 RAs in reducing HbA1c and body weight were associated with greater reductions of MACE.
目的
在2型糖尿病（T2DM）患者中，不同的胰高血糖素样肽-1受体激动剂（GLP-1 RAs）在降低主要动脉粥样硬化性心血管事件（MACE）方面的效果并不一致。本研究的目的是评估通过GLP-1 RA治疗实现的血糖控制程度、体重减轻以及收缩压（SBP）和低密度脂蛋白胆固醇（LDL-C）降低与MACE之间的关联。
方法
检索截至2023年3月的电子数据库（MEDLINE、CENTRAL、SCOPUS）。纳入的研究需为比较T2DM患者中GLP-1 RAs与安慰剂的心血管结局试验（CVOTs）。感兴趣的结局是3点MACE——心血管死亡、心肌梗死或中风。随机效应meta回归分析评估糖化血红蛋白（HbA）、体重、SBP和LDL-C降低与MACE降低之间的关联。
结果
总体而言，纳入了8项CVOTs（60079例患者，30693例使用GLP-1 RAs）。HbA降低与3P-MACE降低相关（对数风险比-0.290 [95%置信区间-0.515；-0.064]，p = 0.012），HbA水平每绝对降低1%，估计风险比降低25%。体重减轻与3P-MACE降低相关（对数风险比-0.068 [95%置信区间-0.135；-0.001]，p = 0.047），体重每降低1 kg，估计风险比降低7%。SBP降低（对数风险比-0.058 [95%置信区间-0.19至0.076]，p = 0.396）和LDL-C降低（对数风险比-0.602 [95%置信区间-4.157；2.953]，p = 0.740）与3P-MACE降低无关。
结论
在T2DM患者中，更有效地降低HbA1c和体重的GLP-1 RAs与更大程度地降低MACE相关。
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