GLP-1 receptor agonists for prevention of cardiorenal outcomes in type 2 diabetes: An updated meta-analysis including the REWIND and PIONEER 6 trials
GLP-1 receptor agonists for prevention of cardiorenal outcomes in type 2 diabetes: An updated meta-analysis including the REWIND and PIONEER 6 trials
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DOI：
10.1111/dom.13847
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发表时间：
2019-08-28
影响因子：
5.8
通讯作者：
Esposito, Katherine
中科院分区：
文献类型：
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作者：
Giugliano, Dario;Maiorino, Maria Ida;Esposito, Katherine
介绍了一项比较胰高血糖素样肽-1受体激动剂（GLP-1 RA）和安慰剂在2型糖尿病（T2 D）患者心肾结局方面的心血管结局试验（CVOT）荟萃分析。进行了截至2019年6月15日的无语言限制的电子检索，以确定合格的试验。对现有试验数据进行荟萃分析，使用随机效应模型计算总体风险比（HR）和95%置信区间（CI）。纳入了来自7项CVOT的数据，包括56004例患者（68.9%患有确诊的心血管疾病）。GLP-1 RA使主要心血管事件（MACE）减少13%（HR，0.87; 95% CI，0.80-0.96; P = 0.011），在有和无心血管疾病（CVD）的患者亚组之间无显著异质性（P = 0.220）。GLP-1 RA还使心血管死亡风险降低12%，非致死性卒中风险降低16%，心力衰竭住院风险降低9%，全因死亡率降低11%，广义复合肾脏结局降低17%;后者似乎仅由大量白蛋白尿减少驱动（HR，0.76 [0.68-0.86]; P = 0.003）。GLP-1 RA在MACE方面具有中度获益，还可减少因心力衰竭住院治疗和全因死亡率;还可显著降低大量白蛋白尿的发生率，而不影响糖尿病肾病的进展。
A meta-analysis of cardiovascular outcome trials (CVOTs) comparing glucagon-like peptide-1 receptor agonists (GLP-1RAs) and placebo concerning cardiorenal outcomes in patients with type 2 diabetes (T2D) is presented. An electronic search without language restrictions up to June 15, 2019 was conducted to determine eligible trials. A meta-analysis of available trial data was undertaken, using a random-effects model to calculate overall hazard ratios (HRs) and 95% confidence intervals (CIs). Data from seven CVOTs, comprising 56 004 patients (68.9% with established cardiovascular disease) were included. GLP-1RA reduced major cardiovascular events (MACE) by 13% (HR, 0.87; 95% CI, 0.80-0.96; P = 0.011) with a non-significant heterogeneity between subgroups of patients with and without cardiovascular disease (CVD) (P = 0.220). GLP-1RA also reduced the risk of cardiovascular death by 12%, of non-fatal stroke by 16%, of hospitalization for heart failure by 9%, of all-cause mortality by 11%, and the broad composite kidney outcome by 17%; the latter appeared to be driven only by a reduction in macroalbuminuria (HR, 0.76 [0.68-0.86]; P = 0.003). GLP-1RAs have moderate benefits concerning MACE, and also reduce hospitalization for heart failure and all-cause mortality; they also robustly reduce the incidence of macroalbuminuria, without affecting the progression of diabetic renal disease.