Cardiovascular and microvascular outcomes of glucagon-like peptide-1 receptor agonists in type 2 diabetes: a meta-analysis of randomized controlled cardiovascular outcome trials with trial sequential analysis.
Cardiovascular and microvascular outcomes of glucagon-like peptide-1 receptor agonists in type 2 diabetes: a meta-analysis of randomized controlled cardiovascular outcome trials with trial sequential analysis.
复制标题
胰高血糖素样肽 1 受体激动剂治疗 2 型糖尿病的心血管和微血管结局：随机对照心血管结局试验与试验序贯分析的荟萃分析
DOI：
10.1186/s40360-018-0246-x
复制
发表时间：
2018-09-17
影响因子：
2.9
通讯作者：
Bi Y
中科院分区：
文献类型：
--
作者：
Zhang X;Shao F;Zhu L;Ze Y;Zhu D;Bi Y
疗效试验显示，胰高血糖素样肽-1受体（GLP 1 R）激动剂除了降低血糖外，还降低了代谢危险因素，但该类药物的心血管和微血管疗效仍有待确定。我们的目的是通过试验序贯分析进行荟萃分析，评价GLP 1 R激动剂的总体心血管和微血管疗效。纳入了随机对照、心血管结局试验，包括至少2000例患者-年的随访和100例复合心血管事件。进行试验序贯分析（TSA）并对证据质量进行评级。纳入了来自4项大型试验的33457例患者和4105例心血管事件。GLP 1 R激动剂与全因死亡风险的统计学显著降低相关（风险比[HR]：0.88，95% CI：0.81 - 0.95;需要治疗的人数[NNT]：286人-年），心血管死亡率（HR：0.87，95% CI：0.79 - 0.96; NNT：412人-年），卒中（HR：0.87，95% CI：0.76 - 0.98; NNT：209人-年）和复合不良心血管结局（MACE; HR：0.91，95% CI：0.85 - 0.96; NNT：241人-年）。在有充血性心力衰竭病史的患者中，MACE的获益程度减弱（HR：0.96，95% CI：0.85 - 1.08; HR：0.87，95% CI：0.77 - 1.00）。因心力衰竭和心肌梗死住院的风险无显著差异。基于GRADE方法，证据质量被认为是中等至高。TSA提供了全因死亡率降低10%，MACE降低15%，心力衰竭住院率降低15%的有力证据，但心血管死亡率和心肌梗死的证据仍不确定。GLP 1 R激动剂在数值上降低了肾病的发生率，但视网膜病变的风险相似。试验序贯分析的荟萃分析表明，GLP 1 R激动剂显著降低了全因死亡率和复合心血管结局的风险，但心血管死亡率的降低仍有待证实。本文的在线版本（10.1186/s40360-018-0246-x）包含补充材料，可供授权用户使用。
Efficacy trials showed that glucagon-like peptide–1 receptor (GLP1R) agonists reduced metabolic risk factors in addition to glucose lowering, but the cardiovascular and microvascular efficacy of this drug class remains to be determined. We aimed to evaluate the overall cardiovascular and microvascular efficacy of GLP1R agonists by performing a meta-analysis with trial sequential analysis. Randomized controlled, cardiovascular outcomes trials including at least 2000 patient-years’ follow-up and 100 composite cardiovascular events were included. Trial sequential analysis (TSA) was performed and the quality of evidence was graded. Thirty-three thousand four hundred fifty-seven patients and 4105 cardiovascular events from 4 large trials were included. GLP1R agonists were associated with a statistically significant reduction in risks for all-cause mortality (hazard ratio [HR]: 0.88, 95% CI: 0.81 to 0.95; number needed to treat [NNT]: 286 person-years), cardiovascular mortality (HR: 0.87, 95% CI: 0.79 to 0.96; NNT: 412 person-years), stroke (HR: 0.87, 95% CI: 0.76 to 0.98; NNT: 209 person-years) and the composite adverse cardiovascular outcome (MACE; HR: 0.91, 95% CI: 0.85 to 0.96; NNT: 241 person-years). The magnitude of benefit on MACE was attenuated in patients with a history of congestive heart failure (HR: 0.96, 95% CI: 0.85 to 1.08 with; HR: 0.87, 95% CI: 0.77 to 1.00 without). The risks for hospitalization for heart failure and myocardial infarction were not significantly different. The quality of the evidence was deemed as moderate to high based on GRADE approach. TSA provided firm evidence for a 10% reduction in all-cause mortality, a 15% reduction in MACE, and lack of a 15% reduction in hospitalization for heart failure, but evidence remains inconclusive for cardiovascular mortality and myocardial infarction. GLP1R agonists numerically reduced the rates for nephropathy but the risk for retinopathy was similar. Meta-analysis with trial sequential analysis suggested that GLP1R agonists significantly reduced the risk for all-cause mortality and composite cardiovascular outcomes, but the reduction of cardiovascular mortality remains to be confirmed. The online version of this article (10.1186/s40360-018-0246-x) contains supplementary material, which is available to authorized users.
登录
查看更多内容
影响因子：
158.5
作者：
Nissen, Steven E.;Wolski, Kathy
通讯作者：
Wolski, Kathy
DOI：
10.1136/bmj.b2535
发表时间：
2009-07-21
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Moher D;Liberati A;Tetzlaff J;Altman DG;PRISMA Group
通讯作者：
PRISMA Group
DOI：
10.1056/nejmoa1603827
发表时间：
2016-07-28
期刊：
The New England journal of medicine
影响因子：
--
作者：
Marso SP;Daniels GH;Brown-Frandsen K;Kristensen P;Mann JF;Nauck MA;Nissen SE;Pocock S;Poulter NR;Ravn LS;Steinberg WM;Stockner M;Zinman B;Bergenstal RM;Buse JB;LEADER Steering Committee;LEADER Trial Investigators
通讯作者：
LEADER Trial Investigators
影响因子：
168.9
作者：
Eng, Conrad;Kramer, Caroline K.;Retnakaran, Ravi
通讯作者：
Retnakaran, Ravi
影响因子：
105.7
作者：
Higgins, JPT;Thompson, SG;Altman, DG
通讯作者：
Altman, DG