新型抗高血糖药物对老年人心血管结局的影响：系统评价和荟萃分析。
Effects of newer anti-hyperglycemic agents on cardiovascular outcomes in older adults: Systematic review and meta-analysis.
机构信息
AdventHealth Translational Research Institute, Orlando, FL, USA.
AdventHealth Translational Research Institute, Orlando, FL, USA.
出版信息
J Diabetes Complications. 2024 Aug;38(8):108783. doi: 10.1016/j.jdiacomp.2024.108783. Epub 2024 Jun 8.
AIM
To demonstrate cardiovascular safety of dipeptidyl peptidase-4 inhibitors (DPP-4i), glucagon-like peptide-1 receptor agonists (GLP-1RA), and sodium/glucose cotransporter 2 inhibitors (SGLT-2i) across age-groups.
METHODS
PubMed, Embase and Cochrane were searched for cardiovascular outcome trials (CVOTs) testing newer agents until August 31, 2022 (PROSPERO ID CRD42021260167). Studies with ≥1000 T2D participants enrolled for ≥12 months were included. Random effect models were used to report relative-risk (RR) for three-point major adverse cardiovascular events (3P-MACE) and its components by age subgroups (65 years; 75 years).
RESULTS
For SGLT-2is, five CVOTs (46,969 patients, 45-50 % ≥65 years) were included. SGLT-2is reduced risk of MACE (RR; 0.91 [CI, 0.85-0.98]); cardiovascular death (CV-death) (RR; 0.84 [CI, 0.73-0.96]); and all-cause mortality (ACM) (RR; 0.86 [CI, 0.79-0.93]) with no difference in subgroups <65 or ≥65 years. For GLP-1RAs, nine CVOTs (n = 64,236, 34-75 % ≥65 years) were included. GLP-1RAs reduced risk of MACE (RR; 0.89 [CI, 0.83-0.95]), stroke (RR; 0.86 [CI, 0.76-0.97]) and ACM (RR; 0.90 [CI, 0.83-0.97]) with no significant difference in subgroups <65 or ≥65 years. Additionally, GLP-1RAs reduced risk of MACE (10 %), ACM (12 %) and CV-death (12 %) with no significant difference in subgroups <75 or ≥75 years. Four CVOTs (n = 33,063; 35-58 % ≥65 years) with DPP-4is were included. There were no significant differences in risk for CV outcomes with DPP-4is compared to placebo in any of the age subgroups.
CONCLUSION
The overall cardiovascular safety profile of newer anti-hyperglycemic agents is consistent in older and younger individuals.
目的
展示不同年龄组中二肽基肽酶-4 抑制剂（DPP-4i）、胰高血糖素样肽-1 受体激动剂（GLP-1RA）和钠/葡萄糖共转运蛋白 2 抑制剂（SGLT-2i）的心血管安全性。
方法
检索 PubMed、Embase 和 Cochrane 数据库，以获取截至 2022 年 8 月 31 日（PROSPERO ID CRD42021260167）的心血管结局试验（CVOT）中测试新型药物的研究。纳入至少有 1000 例 2 型糖尿病患者，且随访时间≥12 个月的研究。采用随机效应模型，根据年龄亚组（65 岁；75 岁）报告主要不良心血管事件（3P-MACE）及其组成部分的相对风险（RR）。
结果
纳入 SGLT-2i 的 5 项 CVOT（46969 例患者，45-50%≥65 岁）。SGLT-2i 降低了 MACE（RR；0.91 [95%CI，0.85-0.98]）、心血管死亡（RR；0.84 [95%CI，0.73-0.96]）和全因死亡率（RR；0.86 [95%CI，0.79-0.93]）的风险，且在<65 岁和≥65 岁亚组之间无差异。纳入 GLP-1RA 的 9 项 CVOT（n=64236 例患者，34-75%≥65 岁）。GLP-1RA 降低了 MACE（RR；0.89 [95%CI，0.83-0.95]）、卒中（RR；0.86 [95%CI，0.76-0.97]）和全因死亡率（RR；0.90 [95%CI，0.83-0.97]）的风险，且在<65 岁和≥65 岁亚组之间无显著差异。此外，GLP-1RA 降低了 MACE（10%）、全因死亡率（12%）和心血管死亡（12%）的风险，且在<75 岁和≥75 岁亚组之间无显著差异。纳入 SGLT-2i 的 4 项 CVOT（n=33063 例患者，35-58%≥65 岁）。与安慰剂相比，SGLT-2i 在任何年龄亚组中对心血管结局的风险均无显著差异。
结论
新型降糖药物的总体心血管安全性在老年人和年轻人中是一致的。
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