司美格鲁肽对2型糖尿病患者心律失常、主要心血管及微血管结局的影响：一项系统评价与荟萃分析
Effect of semaglutide on arrhythmic, major cardiovascular, and microvascular outcomes in patients with type 2 diabetes: a systematic review and meta-analysis.
作者信息
Wu Rui, Xing Bo, Huang Yuting, Zhou Zijun, Sun Boxuan, Yu Liming, Wang Huishan
机构信息
School of Life Sciences and Biopharmaceuticals, Shenyang Pharmaceutical University, Shenyang, Liaoning, China.
State Key Laboratory of Frigid Zone Cardiovascular Disease, Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, Shenyang, Liaoning, China.
出版信息
Front Endocrinol (Lausanne). 2025 Aug 26;16:1554795. doi: 10.3389/fendo.2025.1554795. eCollection 2025.
BACKGROUND
Semaglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist, has shown promise in managing hyperglycemia and reducing cardiovascular (CV) outcomes. However, its effects on arrhythmic, major CV, and microvascular outcomes remain uncertain. This systematic review and meta-analysis aimed to evaluate these outcomes in patients with type 2 diabetes (T2D) treated with semaglutide.
METHODS
We searched the PubMed, Embase, and Cochrane databases for eligible randomized controlled trials (RCTs) reported up to November 2024. We performed a meta-analysis via a random-effects model to estimate overall relative risks (RRs) with 95% confidence intervals (CIs) for arrhythmic, major CV, and microvascular outcomes. We conducted subgroup analyses on the basis of different administration types, treatment comparisons, and treatment durations. Additionally, we performed a meta-regression for retinopathy complications on the basis of baseline patient characteristics.
RESULTS
This meta-analysis included 30 RCTs encompassing 32490 patients with T2D. Compared with the controls, semaglutide significantly reduced the incidence of atrial fibrillation (AF) (RR 0.73, 95% CI 0.54 to 0.98), complete atrioventricular (AV) block (RR 0.22, 95% CI 0.06 to 0.80), death from CV causes (RR 0.76, 95% CI 0.58 to 0.98), and revascularization (RR 0.68, 95% CI 0.52 to 0.88). Subgroup analyses revealed that semaglutide (long-term treatment) reduced the risk of AF, supraventricular tachycardia, and complete AV block. Meta-regression analysis revealed that the heterogeneity of retinopathy complications was not associated with baseline patient characteristics.
CONCLUSION
Semaglutide reduces the risk of AF, complete AV block, death from CV causes, and revascularization in patients with T2D, with long-term treatment showing greater benefits for arrhythmic outcomes.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/, identifier CRD42024618146.
背景
司美格鲁肽是一种胰高血糖素样肽-1（GLP-1）受体激动剂，在控制高血糖和改善心血管（CV）结局方面已显示出前景。然而，其对心律失常、主要心血管和微血管结局的影响仍不确定。本系统评价和荟萃分析旨在评估接受司美格鲁肽治疗的2型糖尿病（T2D）患者的这些结局。
方法
我们检索了截至2024年11月报道的符合条件的随机对照试验（RCT）的PubMed、Embase和Cochrane数据库。我们通过随机效应模型进行荟萃分析，以估计心律失常、主要心血管和微血管结局的总体相对风险（RR）及95%置信区间（CI）。我们基于不同的给药类型、治疗对照和治疗持续时间进行亚组分析。此外，我们根据患者基线特征对视网膜病变并发症进行了荟萃回归分析。
结果
该荟萃分析纳入了30项RCT，涉及32490例T2D患者。与对照组相比，司美格鲁肽显著降低了房颤（AF）的发生率（RR 0.73，95%CI 0.54至0.98）、完全性房室（AV）传导阻滞（RR 0.22，95%CI 0.06至0.80）、心血管原因导致的死亡（RR 0.76，95%CI 0.58至0.98）以及血运重建（RR 0.68，95%CI 0.52至0.88）。亚组分析显示，司美格鲁肽（长期治疗）降低了AF、室上性心动过速和完全性AV传导阻滞的风险。荟萃回归分析显示，视网膜病变并发症的异质性与患者基线特征无关。
结论
司美格鲁肽降低了T2D患者发生AF、完全性AV传导阻滞、心血管原因导致的死亡及血运重建的风险，长期治疗对心律失常结局显示出更大益处。
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