Incretin-based agents in type 2 diabetic patients at cardiovascular risk: compare the effect of GLP-1 agonists and DPP-4 inhibitors on cardiovascular and pancreatic outcomes.
Incretin-based agents in type 2 diabetic patients at cardiovascular risk: compare the effect of GLP-1 agonists and DPP-4 inhibitors on cardiovascular and pancreatic outcomes.
复制标题
基于肠促胰岛素的药物治疗有心血管风险的 2 型糖尿病患者：比较 GLP-1 激动剂和 DPP-4 抑制剂对心血管和胰腺结局的影响
DOI：
10.1186/s12933-017-0512-z
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发表时间：
2017-03-01
影响因子：
9.3
通讯作者：
Yu X
中科院分区：
文献类型：
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作者：
Zhang Z;Chen X;Lu P;Zhang J;Xu Y;He W;Li M;Zhang S;Jia J;Shao S;Xie J;Yang Y;Yu X
以肠促胰岛素为基础的药物，包括二肽基肽酶-4抑制剂（DPP-4Is）和胰高血糖素样肽-1激动剂（glp - 1a），通过GLP-1受体直接或间接地控制高血糖，但对心血管（CV）结局的影响不同。本研究旨在评估和比较以肠促胰岛素为基础的药物对2型糖尿病（T2DM）和高危CV患者的CV和胰腺预后的影响。方法选择6项前瞻性随机对照试验（EXMAINE、SAVOR-TIMI53、TECOS、ELIXA、LEADER和SUSTAIN-6），包括3项DPP-4Is试验和3项GLP-1As试验，共55,248名受试者，评估不同类型肠促胰岛素类药物对死亡、CV结局（CV死亡率、主要CV不良事件、非致死性心肌梗死、非致死性卒中、心力衰竭住院）的影响。胰腺事件（急性胰腺炎和胰腺癌）以及低血糖。当我们评估6项试验的综合效果时，结果表明，与安慰剂相比，以肠促胰岛素为基础的治疗对CV和胰腺结局的总体风险没有显著影响。然而，glp - 1a降低了全因死亡（RR = 0.90, 95% CI 0.82-0.98）和CV死亡率（RR = 0.84, 95% CI 0.73-0.97），而DPP-4Is对CV结局没有显著影响，但增加了急性胰腺炎（OR = 1.76, 95% CI 1.14-2.72）和低血糖（任何和严重低血糖）的风险，而glp - 1a降低了严重低血糖的风险。结论：glp - 1as降低了全因死亡率和CV死亡率以及严重低血糖的风险，而DPP-4Is对CV结果没有影响，但增加了急性胰腺炎和低血糖的风险。
BackgroundIncretin-based agents, including dipeptidyl peptidase-4 inhibitors (DPP-4Is) and glucagon-like peptide-1 agonists (GLP-1As), work via GLP-1 receptor for hyperglycemic control directly or indirectly, but have different effect on cardiovascular (CV) outcomes. The present study is to evaluate and compare effects of incretin-based agents on CV and pancreatic outcomes in patients with type 2 diabetes mellitus (T2DM) and high CV risk.MethodsSix prospective randomized controlled trials (EXMAINE, SAVOR-TIMI53, TECOS, ELIXA, LEADER and SUSTAIN-6), which included three trials for DPP-4Is and three trials for GLP-1As, with 55,248 participants were selected to assess the effect of different categories of incretin-based agents on death, CV outcomes (CV mortality, major adverse CV events, nonfatal myocardial infarction, nonfatal stroke, heart failure hospitalization), pancreatic events (acute pancreatitis and pancreatic cancer) as well as on hypoglycemia.ResultsWhen we evaluated the combined effect of six trials, the results suggested that incretin-based treatment had no significant effect on overall risks of CV and pancreatic outcomes compared with placebo. However, GLP-1As reduced all-cause death (RR = 0.90, 95% CI 0.82–0.98) and CV mortality (RR = 0.84, 95% CI 0.73–0.97), whereas DPP-4Is had no significant effect on CV outcomes but elevated the risk for acute pancreatitis (OR = 1.76, 95% CI 1.14–2.72) and hypoglycemia (both any and severe hypoglycemia), while GLP-1As lowered the risk of severe hypoglycemia.ConclusionsGLP-1As decreased risks of all-cause and CV mortality and severe hypoglycemia, whereas DPP-4Is had no effect on CV outcomes but increased risks in acute pancreatitis and hypoglycemia.