Tang Ansel Shao Pin, Hsu Jovan Teng Yuan, Chong Sheena Kar Shuan, Quek Jingxuan, Shek Genevieve, Sulaimi Farisah, Chan Kai En, Anand Vickram Vijay, Chong Bryan, Mehta Anurag, Toh Sue-Anne, Muthiah Mark, Dimitriadis Georgios K, le Roux Carel W, Chan Mark Yan-Yee, Mamas Mamas Andreas, Chin Yip Han, Chew Nicholas W S
NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Wallace Wurth, University of New South Wales, Sydney, NSW, Australia.
Cardiovasc Diabetol. 2025 Jul 12;24(1):285. doi: 10.1186/s12933-025-02840-3.
Glucagon like peptide-1 receptor agonist (GLP-1RA) use in individuals with high atherosclerotic cardiovascular disease (ASCVD) risk reduces major adverse cardiovascular events (MACE). However, its clinical impact, in terms of numbers needed to treat (NNT), efficacy and safety profile in reducing the risk of myocardial infarction (MI) and the individual ASCVD constituents remain unclear.
Electronic databases, Medline and Embase were reviewed for randomized trials from inception to 29 May 2025. Risk-reduction effect of GLP-1RA were pooled using pairwise meta-analysis with random-effects model. The primary outcome was MI, and secondary outcomes were the individual ASCVD constituents.
109,846 patients from 25 unique studies were included. Over a follow-up duration of 3.48 ± 1.51 (1.55 to 5.47) years, GLP-1RA reduced the risk of total MI (RR: 0.86, p < 0.01), with numbers needed to benefit (NNTB) of 207 to prevent one event of MI. Higher body mass index was associated with greater MI risk reduction (β: -0.09, p = 0.03) in GLP-1RA users. GLP-1RA reduced cardiovascular mortality (RR: 0.87, p < 0.01, NNTB 170), MACE (RR: 0.87, p < 0.01, NNTB 67) and stroke (RR: 0.88, p < 0.01, NNTB 335) compared to placebo. GLP-1RA commonly resulted in gastrointestinal side-effects amongst other systems (RR: 1.55, p < 0.01, NNTH 9).
GLP-1RA reduced the risk of MI, stroke, cardiovascular mortality and MACE in a broad range of patients with and without T2DM and/or prior ASCVD, supporting its role in ASCVD prevention, especially in the cohort with high BMI.
Open Science Framework ( https://doi.org/10.17605/OSF.IO/7VXN5 ).
在具有高动脉粥样硬化性心血管疾病（ASCVD）风险的个体中使用胰高血糖素样肽-1受体激动剂（GLP-1RA）可降低主要不良心血管事件（MACE）。然而，就治疗所需人数（NNT）、降低心肌梗死（MI）风险的疗效和安全性概况以及个体ASCVD成分而言，其临床影响仍不明确。
检索电子数据库Medline和Embase，查找从数据库建立至2025年5月29日的随机试验。使用随机效应模型的成对荟萃分析汇总GLP-1RA的风险降低效果。主要结局是MI，次要结局是个体ASCVD成分。
纳入了来自25项独特研究的109846例患者。在3.48±1.51（1.55至5.47）年的随访期间，GLP-1RA降低了总MI风险（RR：0.86，p<0.01），预防1例MI事件的受益所需人数（NNTB）为207。在使用GLP-1RA的患者中，较高的体重指数与更大的MI风险降低相关（β：-0.09，p=0.03）。与安慰剂相比，GLP-1RA降低了心血管死亡率（RR：0.87，p<0.01，NNTB 170）、MACE（RR：0.87，p<0.01，NNTB 67）和卒中（RR：0.88，p<0.01，NNTB 335）。GLP-1RA除其他系统外通常会导致胃肠道副作用（RR：1.55，p<0.01，NNTH 9）。
GLP-1RA降低了广泛的有和没有2型糖尿病和/或既往ASCVD的患者发生MI、卒中、心血管死亡率和MACE的风险，支持其在ASCVD预防中的作用，尤其是在高BMI队列中。
