GLP-1RAs and SGLT2is Reduce Cardiovascular Events Independent of Reductions of Systolic Blood Pressure and Body Weight: A Meta-Analysis with Meta-Regression
Introduction The impact of reduction of systolic blood pressure or body weight on reduction of cardiovascular events during the treatment with glucagon-like peptide 1 receptor agonists (GLP-1RAs) or sodium-glucose cotransporter 2 inhibitors (SGLT2is) for type 2 diabetes is unclear. Methods We search...
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description | Introduction
The impact of reduction of systolic blood pressure or body weight on reduction of cardiovascular events during the treatment with glucagon-like peptide 1 receptor agonists (GLP-1RAs) or sodium-glucose cotransporter 2 inhibitors (SGLT2is) for type 2 diabetes is unclear.
Methods
We searched Embase and PubMed. We performed meta-analysis using hazard ratio (HR) and 95% confidence interval (CI) as effect size stratified by drug class on six endpoints of interest, which were major adverse cardiovascular events (MACE), hospitalization for heart failure (HHF), cardiovascular death (CVD), myocardial infarction (MI), stroke, and all-cause death (ACD). We performed meta-regression to assess the difference between GLP-1RAs and SGLT2is, and the impact of reduction of systolic blood pressure or body weight on reduction of cardiovascular events.
Results
We included 11 randomized trials. Compared with placebo, SGLT2is reduced HHF by 32% (HR 0.68, 95% CI 0.60–0.76) whereas GLP-1RAs reduced HHF by only 9% (HR 0.91, 95% CI 0.83–0.99). The benefit from SGLT2is on HHF was significantly greater than that from GLP-1RAs (
P
subgroup
= 0.004). GLP-1RAs reduced stroke by 16% (HR 0.84, 95% CI 0.76–0.93) whereas SGLT2is did not reduce stroke (HR 0.96, 95% CI 0.82–1.12). GLP-1RAs and SGLT2is similarly reduced MACE by 12%, CVD by 15%, MI by 9%, and ACD by 13%. The effects of systolic blood pressure reduction and body weight reduction on the logarithms of HRs of GLP-1RAs or SGLT2is vs. placebo as for reducing six endpoints of interest were not statistically significant (β ranged from − 0.145 to 0.269, and
P
ranged from 0.211 to 0.941).
Conclusions
GLP-1RAs and SGLT2is lead to similar benefits on MACE, CVD, MI, and ACD in adults with type 2 diabetes. The benefit from SGLT2is on HHF is greater than that from GLP-1RAs, while GLP-1RAs vs. placebo significantly reduce stroke whereas SGLT2is do not. The two drug classes reduce cardiovascular events independent of reductions of systolic blood pressure and body weight. |
doi_str_mv | 10.1007/s13300-020-00912-z |
format | Article |
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The impact of reduction of systolic blood pressure or body weight on reduction of cardiovascular events during the treatment with glucagon-like peptide 1 receptor agonists (GLP-1RAs) or sodium-glucose cotransporter 2 inhibitors (SGLT2is) for type 2 diabetes is unclear.
Methods
We searched Embase and PubMed. We performed meta-analysis using hazard ratio (HR) and 95% confidence interval (CI) as effect size stratified by drug class on six endpoints of interest, which were major adverse cardiovascular events (MACE), hospitalization for heart failure (HHF), cardiovascular death (CVD), myocardial infarction (MI), stroke, and all-cause death (ACD). We performed meta-regression to assess the difference between GLP-1RAs and SGLT2is, and the impact of reduction of systolic blood pressure or body weight on reduction of cardiovascular events.
Results
We included 11 randomized trials. Compared with placebo, SGLT2is reduced HHF by 32% (HR 0.68, 95% CI 0.60–0.76) whereas GLP-1RAs reduced HHF by only 9% (HR 0.91, 95% CI 0.83–0.99). The benefit from SGLT2is on HHF was significantly greater than that from GLP-1RAs (
P
subgroup
= 0.004). GLP-1RAs reduced stroke by 16% (HR 0.84, 95% CI 0.76–0.93) whereas SGLT2is did not reduce stroke (HR 0.96, 95% CI 0.82–1.12). GLP-1RAs and SGLT2is similarly reduced MACE by 12%, CVD by 15%, MI by 9%, and ACD by 13%. The effects of systolic blood pressure reduction and body weight reduction on the logarithms of HRs of GLP-1RAs or SGLT2is vs. placebo as for reducing six endpoints of interest were not statistically significant (β ranged from − 0.145 to 0.269, and
P
ranged from 0.211 to 0.941).
Conclusions
GLP-1RAs and SGLT2is lead to similar benefits on MACE, CVD, MI, and ACD in adults with type 2 diabetes. The benefit from SGLT2is on HHF is greater than that from GLP-1RAs, while GLP-1RAs vs. placebo significantly reduce stroke whereas SGLT2is do not. The two drug classes reduce cardiovascular events independent of reductions of systolic blood pressure and body weight.</description><identifier>ISSN: 1869-6953</identifier><identifier>EISSN: 1869-6961</identifier><identifier>DOI: 10.1007/s13300-020-00912-z</identifier><identifier>PMID: 32852698</identifier><language>eng</language><publisher>Cheshire: Springer Healthcare</publisher><subject>Blood pressure ; Body weight ; Brief Report ; Cardiology ; Cardiovascular disease ; Diabetes ; Drug therapy ; Endocrinology ; GLP-1 receptor agonists ; Hypoglycemic agents ; Internal Medicine ; Medicine ; Medicine & Public Health ; Meta-analysis ; Type 2 diabetes</subject><ispartof>Diabetes therapy, 2020-10, Vol.11 (10), p.2429-2440</ispartof><rights>The Author(s) 2020</rights><rights>COPYRIGHT 2020 Springer</rights><rights>The Author(s) 2020. This work is published under http://creativecommons.org/licenses/by-nc/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c502t-323ec2dc499c9e8f955b8195ed6e5360353440c055b43036eef834abeda5df843</citedby><cites>FETCH-LOGICAL-c502t-323ec2dc499c9e8f955b8195ed6e5360353440c055b43036eef834abeda5df843</cites><orcidid>0000-0003-0374-2539 ; 0000-0001-5013-657X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7509017/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7509017/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,27901,27902,41096,42165,51551,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32852698$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Qiu, Mei</creatorcontrib><creatorcontrib>Ding, Liang-Liang</creatorcontrib><creatorcontrib>Zhang, Miao</creatorcontrib><creatorcontrib>Lin, Jin-Hao</creatorcontrib><creatorcontrib>Wei, Xu-Bin</creatorcontrib><creatorcontrib>Huang, Hua</creatorcontrib><title>GLP-1RAs and SGLT2is Reduce Cardiovascular Events Independent of Reductions of Systolic Blood Pressure and Body Weight: A Meta-Analysis with Meta-Regression</title><title>Diabetes therapy</title><addtitle>Diabetes Ther</addtitle><addtitle>Diabetes Ther</addtitle><description>Introduction
The impact of reduction of systolic blood pressure or body weight on reduction of cardiovascular events during the treatment with glucagon-like peptide 1 receptor agonists (GLP-1RAs) or sodium-glucose cotransporter 2 inhibitors (SGLT2is) for type 2 diabetes is unclear.
Methods
We searched Embase and PubMed. We performed meta-analysis using hazard ratio (HR) and 95% confidence interval (CI) as effect size stratified by drug class on six endpoints of interest, which were major adverse cardiovascular events (MACE), hospitalization for heart failure (HHF), cardiovascular death (CVD), myocardial infarction (MI), stroke, and all-cause death (ACD). We performed meta-regression to assess the difference between GLP-1RAs and SGLT2is, and the impact of reduction of systolic blood pressure or body weight on reduction of cardiovascular events.
Results
We included 11 randomized trials. Compared with placebo, SGLT2is reduced HHF by 32% (HR 0.68, 95% CI 0.60–0.76) whereas GLP-1RAs reduced HHF by only 9% (HR 0.91, 95% CI 0.83–0.99). The benefit from SGLT2is on HHF was significantly greater than that from GLP-1RAs (
P
subgroup
= 0.004). GLP-1RAs reduced stroke by 16% (HR 0.84, 95% CI 0.76–0.93) whereas SGLT2is did not reduce stroke (HR 0.96, 95% CI 0.82–1.12). GLP-1RAs and SGLT2is similarly reduced MACE by 12%, CVD by 15%, MI by 9%, and ACD by 13%. The effects of systolic blood pressure reduction and body weight reduction on the logarithms of HRs of GLP-1RAs or SGLT2is vs. placebo as for reducing six endpoints of interest were not statistically significant (β ranged from − 0.145 to 0.269, and
P
ranged from 0.211 to 0.941).
Conclusions
GLP-1RAs and SGLT2is lead to similar benefits on MACE, CVD, MI, and ACD in adults with type 2 diabetes. The benefit from SGLT2is on HHF is greater than that from GLP-1RAs, while GLP-1RAs vs. placebo significantly reduce stroke whereas SGLT2is do not. The two drug classes reduce cardiovascular events independent of reductions of systolic blood pressure and body weight.</description><subject>Blood pressure</subject><subject>Body weight</subject><subject>Brief Report</subject><subject>Cardiology</subject><subject>Cardiovascular disease</subject><subject>Diabetes</subject><subject>Drug therapy</subject><subject>Endocrinology</subject><subject>GLP-1 receptor agonists</subject><subject>Hypoglycemic agents</subject><subject>Internal Medicine</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Meta-analysis</subject><subject>Type 2 diabetes</subject><issn>1869-6953</issn><issn>1869-6961</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>BENPR</sourceid><recordid>eNp9kl1v0zAUhiMEYtPYH-ACWeKGmwx_xKnNBVJXjTKpiKkb4tJy7ZPUUxp3dlLU_Zb9WJxllI8LIjl27Oe855z4zbLXBJ8RjCfvI2EM4xzTNLAkNL9_lh0TUcq8lCV5flhzdpSdxniL08OklIS8zI4YFZyWUhxnD_PFVU6W04h0a9H1fHFDXURLsL0BNNPBOr_T0fSNDuhiB20X0WVrYQvp1XbIVyPbOd_G4et6HzvfOIPOG-8tugoQYx_gUf3c2z36Dq5edx_QFH2BTufTVjf7mFL-cN163FpCPUQlxVfZi0o3EU6f5pPs26eLm9nnfPF1fjmbLnLDMe1yRhkYak0hpZEgKsn5ShDJwZbAWYkZZ0WBDU7bBcOsBKgEK_QKrOa2EgU7yT6Outt-tQFrUmdBN2ob3EaHvfLaqb9PWrdWtd-pCccSk0kSePckEPxdD7FTGxcNNI1uwfdR0YJNBB8uIKFv_0FvfR_SX0gUJ5SJkqaKD1StG1CurXzKawZRNS05Sf0IIhJFR8oEH2OA6lAywWpwiRpdopJL1KNL1H0KevNns4eQX55IABuBmI7aGsLvCv8j-xNM2MgW</recordid><startdate>20201001</startdate><enddate>20201001</enddate><creator>Qiu, Mei</creator><creator>Ding, Liang-Liang</creator><creator>Zhang, Miao</creator><creator>Lin, Jin-Hao</creator><creator>Wei, Xu-Bin</creator><creator>Huang, Hua</creator><general>Springer Healthcare</general><general>Springer</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>NAPCQ</scope><scope>PHGZM</scope><scope>PHGZT</scope><scope>PIMPY</scope><scope>PJZUB</scope><scope>PKEHL</scope><scope>PPXIY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-0374-2539</orcidid><orcidid>https://orcid.org/0000-0001-5013-657X</orcidid></search><sort><creationdate>20201001</creationdate><title>GLP-1RAs and SGLT2is Reduce Cardiovascular Events Independent of Reductions of Systolic Blood Pressure and Body Weight: A Meta-Analysis with Meta-Regression</title><author>Qiu, Mei ; Ding, Liang-Liang ; Zhang, Miao ; Lin, Jin-Hao ; Wei, Xu-Bin ; Huang, Hua</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c502t-323ec2dc499c9e8f955b8195ed6e5360353440c055b43036eef834abeda5df843</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Blood pressure</topic><topic>Body weight</topic><topic>Brief Report</topic><topic>Cardiology</topic><topic>Cardiovascular disease</topic><topic>Diabetes</topic><topic>Drug therapy</topic><topic>Endocrinology</topic><topic>GLP-1 receptor agonists</topic><topic>Hypoglycemic agents</topic><topic>Internal Medicine</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Meta-analysis</topic><topic>Type 2 diabetes</topic><toplevel>online_resources</toplevel><creatorcontrib>Qiu, Mei</creatorcontrib><creatorcontrib>Ding, Liang-Liang</creatorcontrib><creatorcontrib>Zhang, Miao</creatorcontrib><creatorcontrib>Lin, Jin-Hao</creatorcontrib><creatorcontrib>Wei, Xu-Bin</creatorcontrib><creatorcontrib>Huang, Hua</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest Central (New)</collection><collection>ProQuest One Academic (New)</collection><collection>Publicly Available Content Database</collection><collection>ProQuest Health & Medical Research Collection</collection><collection>ProQuest One Academic Middle East (New)</collection><collection>ProQuest One Health & Nursing</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Diabetes therapy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Qiu, Mei</au><au>Ding, Liang-Liang</au><au>Zhang, Miao</au><au>Lin, Jin-Hao</au><au>Wei, Xu-Bin</au><au>Huang, Hua</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>GLP-1RAs and SGLT2is Reduce Cardiovascular Events Independent of Reductions of Systolic Blood Pressure and Body Weight: A Meta-Analysis with Meta-Regression</atitle><jtitle>Diabetes therapy</jtitle><stitle>Diabetes Ther</stitle><addtitle>Diabetes Ther</addtitle><date>2020-10-01</date><risdate>2020</risdate><volume>11</volume><issue>10</issue><spage>2429</spage><epage>2440</epage><pages>2429-2440</pages><issn>1869-6953</issn><eissn>1869-6961</eissn><abstract>Introduction
The impact of reduction of systolic blood pressure or body weight on reduction of cardiovascular events during the treatment with glucagon-like peptide 1 receptor agonists (GLP-1RAs) or sodium-glucose cotransporter 2 inhibitors (SGLT2is) for type 2 diabetes is unclear.
Methods
We searched Embase and PubMed. We performed meta-analysis using hazard ratio (HR) and 95% confidence interval (CI) as effect size stratified by drug class on six endpoints of interest, which were major adverse cardiovascular events (MACE), hospitalization for heart failure (HHF), cardiovascular death (CVD), myocardial infarction (MI), stroke, and all-cause death (ACD). We performed meta-regression to assess the difference between GLP-1RAs and SGLT2is, and the impact of reduction of systolic blood pressure or body weight on reduction of cardiovascular events.
Results
We included 11 randomized trials. Compared with placebo, SGLT2is reduced HHF by 32% (HR 0.68, 95% CI 0.60–0.76) whereas GLP-1RAs reduced HHF by only 9% (HR 0.91, 95% CI 0.83–0.99). The benefit from SGLT2is on HHF was significantly greater than that from GLP-1RAs (
P
subgroup
= 0.004). GLP-1RAs reduced stroke by 16% (HR 0.84, 95% CI 0.76–0.93) whereas SGLT2is did not reduce stroke (HR 0.96, 95% CI 0.82–1.12). GLP-1RAs and SGLT2is similarly reduced MACE by 12%, CVD by 15%, MI by 9%, and ACD by 13%. The effects of systolic blood pressure reduction and body weight reduction on the logarithms of HRs of GLP-1RAs or SGLT2is vs. placebo as for reducing six endpoints of interest were not statistically significant (β ranged from − 0.145 to 0.269, and
P
ranged from 0.211 to 0.941).
Conclusions
GLP-1RAs and SGLT2is lead to similar benefits on MACE, CVD, MI, and ACD in adults with type 2 diabetes. The benefit from SGLT2is on HHF is greater than that from GLP-1RAs, while GLP-1RAs vs. placebo significantly reduce stroke whereas SGLT2is do not. The two drug classes reduce cardiovascular events independent of reductions of systolic blood pressure and body weight.</abstract><cop>Cheshire</cop><pub>Springer Healthcare</pub><pmid>32852698</pmid><doi>10.1007/s13300-020-00912-z</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0003-0374-2539</orcidid><orcidid>https://orcid.org/0000-0001-5013-657X</orcidid><oa>free_for_read</oa></addata></record> |
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subjects | Blood pressure Body weight Brief Report Cardiology Cardiovascular disease Diabetes Drug therapy Endocrinology GLP-1 receptor agonists Hypoglycemic agents Internal Medicine Medicine Medicine & Public Health Meta-analysis Type 2 diabetes |
title | GLP-1RAs and SGLT2is Reduce Cardiovascular Events Independent of Reductions of Systolic Blood Pressure and Body Weight: A Meta-Analysis with Meta-Regression |
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