钠-葡萄糖协同转运蛋白 2 抑制剂对心肾结局的影响：一项更新的系统评价和荟萃分析。
The effectiveness of sodium-glucose co-transporter 2 inhibitors on cardiorenal outcomes: an updated systematic review and meta-analysis.
机构信息
Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
Division of Cardiology, Centre for Cardiovascular Innovation, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
出版信息
Cardiovasc Diabetol. 2024 Feb 15;23(1):72. doi: 10.1186/s12933-024-02154-w.
BACKGROUND
The 2022 Canadian Cardiovascular Society (CCS) cardiorenal guideline provided clinical recommendations on sodium-glucose co-transport 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) use. Since then, additional trials of relevance for SGLT2i have been published. This update re-evaluates the clinical recommendations for using SGLTi and their indirect comparison with existing evidence on GLP-1RA as compared to the standard of care to reduce cardiorenal morbidity and mortality.
METHODS
We updated our existing search and screening of the literature from September 2021 to April 2023 for randomized controlled trials of SGLT2i and GLP-1RA with placebo control. We conducted risk of bias assessment, data extraction and updated our meta-analysis of studies with similar interventions and components. The certainty of the evidence was determined using GRADE.
RESULTS
Evidence from three new trials and additional results from an updated existing trial on SGLT2i met our inclusion criteria after an updated search. Across all the included studies, the total sample size was 151,023 adults, with 90,943 in SGLT2i trials and 60,080 in GLP-1 RA trials. The mean age ranged from 59.9 to 68.4 years. Compared with standard care, the use of SGLT2i and GLP-1 RA showed significant reductions in the outcomes of cardiovascular (CV) mortality (14% & 13%), any-cause mortality (12% & 12%), major adverse CV events (MACE) (11% & 14%), heart failure (HF) hospitalization (30% & 9%), CV death or HF hospitalization (23% & 11%), and kidney composite outcome (32% & 22%). In participants with T2D, both classes demonstrated significant cardiorenal protection. But, only GLP-1RA showed a reduction in non-fatal stroke (16%) and only SGLT2i showed a reduction in HF hospitalization (30%) in this population of people living with T2D.
CONCLUSIONS
This updated and comprehensive meta-analysis substantiates and strengthens the clinical recommendations of the CCS cardiorenal guidelines.
背景
2022 年加拿大心血管学会（CCS）心脏肾脏指南提供了钠-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）使用的临床建议。此后，又发表了一些与 SGLT2i 相关的临床试验。本更新重新评估了使用 SGLTi 的临床建议，并与 GLP-1RA 的现有证据进行了间接比较，以评估其与标准治疗相比降低心肾发病率和死亡率的效果。
方法
我们对 2021 年 9 月至 2023 年 4 月期间发表的 SGLT2i 和 GLP-1RA 与安慰剂对照的随机对照试验进行了现有搜索和文献筛选的更新。我们进行了偏倚风险评估、数据提取，并更新了具有相似干预措施和组成部分的研究的荟萃分析。使用 GRADE 确定证据的确定性。
结果
在更新搜索后，三项新试验的证据以及对一项更新现有试验的额外结果符合我们的纳入标准。在所有纳入的研究中，总样本量为 151023 名成年人，其中 SGLT2i 试验 90943 人，GLP-1RA 试验 60080 人。平均年龄范围为 59.9 至 68.4 岁。与标准治疗相比，SGLT2i 和 GLP-1RA 的使用显著降低了心血管（CV）死亡率（14%和 13%）、全因死亡率（12%和 12%）、主要不良 CV 事件（MACE）（11%和 14%）、心力衰竭（HF）住院率（30%和 9%）、CV 死亡或 HF 住院率（23%和 11%）以及肾脏复合结局（32%和 22%）。在 2 型糖尿病患者中，两类药物均表现出显著的心肾保护作用。但只有 GLP-1RA 显示可降低非致死性卒中（16%），只有 SGLT2i 显示可降低 HF 住院率（30%）。
结论
本更新和全面的荟萃分析证实并加强了 CCS 心脏肾脏指南的临床建议。
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