Bao Yu, Hu Yucai, Shi Menglong, Zhao Zhiqiang
First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China.
National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China.
Diabetes Obes Metab. 2025 Mar;27(3):1096-1112. doi: 10.1111/dom.16107. Epub 2024 Dec 6.
Epicardial adipose tissue (EAT) plays a significant role in several cardiovascular diseases. As a correctable risk factor and potential therapeutic target, reducing EAT has multiple cardiovascular benefits, especially in those with abnormal glucolipid metabolism. The objective of this research was to compare the effects of sodium-glucose cotransporter 2 (SGLT2) inhibitors, glucagon-like peptide-1 (GLP-1) agonists, and exercise on the thickness of EAT and indicators of glucolipid metabolism in people with type 2 diabetes mellitus (T2DM), obesity, and T2DM with obesity.
We searched four electronic databases: PubMed, EMBASE, the Cochrane Library, and Web of Science for articles before 31 January 2024, regardless of language. We included randomized controlled trials and a small number of case-control studies in this network meta-analysis. Differences in mean changes in EAT, body mass index, and glucolipid metabolism-related metrics were assessed.
A comprehensive analysis was conducted on 16 trials (15 randomized controlled trials and one case-control study), comprising a total of 867 people. SGLT2 inhibitors were significantly better at reducing EAT than placebo (standard mean different [SMD] = -0.85 cm [95% confidence interval (CI) -1.39, -0.31]); a similar result was observed for exercise compared with placebo (SMD = -0.78 cm [95% CI -1.37, -0.18]). SGLT2 inhibitors were also significantly better at reducing EAT than GLP-1 agonists and conventional hypoglycaemic therapy (e.g., metformin or insulin; SMD = -0.74 cm [95% CI -1.45, -0.02] and SMD = -1.69 cm [95% CI -2.38, -0.99], respectively). SGLT2 inhibitors were significantly better than placebo at reducing body mass index (MD = -0.90 kg/m [95% CI -1.14, -0.66]) and glycosylated haemoglobin (MD = -0.52% [95%CI -0.86, -0.18]). A similar result was observed when comparing GLP-1 agonists and placebo (MD = -0.48% [95% CI -0.93, -0.03]). Changes in total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol were not statistically significant between interventions.
SGLT2 inhibitors have a distinct advantage over both placebo and other therapies at lowering EAT thickness, a result supported by direct comparisons and surface under the cumulative ranking curve analysis. Therefore, SGLT2 inhibitors should be prioritized as a treatment to reduce EAT in individuals with aberrant glucolipid levels, such as patients with T2DM and/or obesity.
心外膜脂肪组织（EAT）在多种心血管疾病中起重要作用。作为一个可纠正的危险因素和潜在的治疗靶点，减少EAT具有多种心血管益处，尤其是在糖脂代谢异常的人群中。本研究的目的是比较钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂、胰高血糖素样肽-1（GLP-1）激动剂和运动对2型糖尿病（T2DM）患者、肥胖患者以及肥胖合并T2DM患者的EAT厚度和糖脂代谢指标的影响。
我们检索了四个电子数据库：PubMed、EMBASE、Cochrane图书馆和Web of Science，检索截至2024年1月31日的文章，不限语言。本网络荟萃分析纳入了随机对照试验和少量病例对照研究。评估了EAT、体重指数和糖脂代谢相关指标的平均变化差异。
对16项试验（15项随机对照试验和1项病例对照研究）进行了综合分析，共纳入867人。SGLT2抑制剂在减少EAT方面显著优于安慰剂（标准平均差[SMD]=-0.85cm[95%置信区间（CI）-1.39，-0.31]）；与安慰剂相比，运动也观察到类似结果（SMD=-0.78cm[95%CI-1.37，-0.18]）。SGLT2抑制剂在减少EAT方面也显著优于GLP-1激动剂和传统降糖治疗（如二甲双胍或胰岛素；SMD分别为-0.74cm[95%CI-1.45，-0.02]和-1.69cm[95%CI-2.38，-0.99]）。SGLT2抑制剂在降低体重指数（MD=-0.90kg/m[95%CI-1.14，-0.66]）和糖化血红蛋白（MD=-0.52%[95%CI-0.86，-0.18]）方面显著优于安慰剂。比较GLP-1激动剂和安慰剂时也观察到类似结果（MD=-0.48%[95%CI-0.93，-0.03]）。各干预措施之间总胆固醇、低密度脂蛋白胆固醇和高密度脂蛋白胆固醇的变化无统计学意义。
SGLT2抑制剂在降低EAT厚度方面比安慰剂和其他疗法具有明显优势，这一结果得到直接比较和累积排名曲线下面积分析的支持。因此，对于糖脂水平异常的个体，如T2DM和/或肥胖患者，应优先使用SGLT2抑制剂来减少EAT。
