An Xuedong, Sun WenJie, Wen Zhige, Duan LiYun, Zhang YueHong, Kang Xiaomin, Ji Hangyu, Sun Yuting, Jiang Linlin, Zhao Xuefei, Gao Qing, Lian Fengmei
Guang'anmen Hospital of China Academy of Chinese Medical Sciences, Beijing, China.
Shandong University of Traditional Chinese Medicine, Jinan, China.
Diabetes Obes Metab. 2025 Apr;27(4):1735-1751. doi: 10.1111/dom.16228. Epub 2025 Feb 5.
This study aims to systematically evaluate and perform a systematic review and network meta-analysis comparing the comprehensive cardiovascular protective effects of various glucagon-like peptide-1 receptor agonists (GLP-1RAs), focusing on cardiovascular events and risk factors.
We searched PubMed, Embase, Cochrane Library and Web of Science from inception to December 15, 2024. Included studies were published randomized controlled trials (RCTs) comparing GLP-1RAs to placebo or other GLP-1RAs. Missing data were standardized, and network meta-analysis was performed using Stata 17.0. Study heterogeneity, publication bias and evidence quality were assessed using the Cochrane Risk of Bias tool and Confidence in Network Meta-Analysis (CINeMA).
As of December 15, 2024, a total of 18 313 articles were retrieved. Based on the inclusion and exclusion criteria, 156 high-quality studies were included, incorporating 144 782 patients and 14 different GLP-1RAs. The network meta-analysis demonstrated low heterogeneity, ensuring the reliability of the results. Comprehensive analysis revealed the following: Efpeglenatide was the most effective in reducing major adverse cardiovascular events. Oral semaglutide shows more significant advantages in reducing all-cause mortality and cardiovascular mortality. Orforglipron excelled in glycaemic control and weight reduction. SC-Semaglutide showed the greatest efficacy in lowering both systolic blood pressure and diastolic blood pressure, Liraglutide showed the greatest efficacy in lowering total cholesterol, Noiiglutide in triglycerides and Taspoglutide in low-density lipoprotein cholesterol, but no GLP-1RAs in high-density lipoprotein cholesterol. GLP-1RAs did not significantly increase the incidence of adverse events, but Orforglipron and Taspoglutide significantly increased the incidence of gastrointestinal adverse events compared with placebo.
This study compared the cardiovascular benefits of different GLP-1RAs, including reductions in cardiovascular events and improvements in multiple cardiovascular risk factors. However, due to limitations in the quantity and quality of the included studies, the conclusions should be interpreted with caution. Future large-scale, high-quality clinical trials are needed to validate these findings and further optimize comprehensive cardiovascular management strategies for patients.
本研究旨在系统评价并进行一项系统综述和网状Meta分析，比较各种胰高血糖素样肽-1受体激动剂（GLP-1RAs）的综合心血管保护作用，重点关注心血管事件和危险因素。
我们检索了从创刊至2024年12月15日的PubMed、Embase、Cochrane图书馆和Web of Science。纳入的研究为已发表的随机对照试验（RCTs），比较了GLP-1RAs与安慰剂或其他GLP-1RAs。对缺失数据进行标准化处理，并使用Stata 17.0进行网状Meta分析。使用Cochrane偏倚风险工具和网状Meta分析置信度（CINeMA）评估研究异质性、发表偏倚和证据质量。
截至2024年12月15日，共检索到18313篇文章。根据纳入和排除标准，纳入了156项高质量研究，涉及144782名患者和14种不同的GLP-1RAs。网状Meta分析显示异质性较低，确保了结果的可靠性。综合分析显示：依弗那肽在降低主要不良心血管事件方面最有效。口服司美格鲁肽在降低全因死亡率和心血管死亡率方面显示出更显著的优势。奥佛必普在血糖控制和体重减轻方面表现出色。皮下注射司美格鲁肽在降低收缩压和舒张压方面疗效最佳，利拉鲁肽在降低总胆固醇方面疗效最佳，诺和鲁肽在降低甘油三酯方面疗效最佳，他司鲁肽在降低低密度脂蛋白胆固醇方面疗效最佳，但在提高高密度脂蛋白胆固醇方面没有一种GLP-1RAs有显著效果。GLP-1RAs并未显著增加不良事件的发生率，但与安慰剂相比，奥佛必普和他司鲁肽显著增加了胃肠道不良事件的发生率。
本研究比较了不同GLP-1RAs的心血管益处，包括减少心血管事件和改善多种心血管危险因素。然而，由于纳入研究的数量和质量存在局限性，对结论应谨慎解读。未来需要进行大规模、高质量的临床试验来验证这些发现，并进一步优化患者的综合心血管管理策略。
