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Effects of glucagon-like peptide-1 receptor agonists on mortality and cardiovascular events: A comprehensive meta-analysis of randomized controlled trials.
Int J Cardiol. 2017 Aug 01; 240:414-421.IJ

Abstract

INTRODUCTION

The publication of the results of LEADER and SUSTAIN-6 trials suggested a possible beneficial effect of the class of GLP-1 receptor agonists on cardiovascular morbidity and mortality. The aim of the present meta-analysis is to collect and synthetize all available evidence on the effect of GLP-1 receptor agonists on cardiovascular events and mortality.

METHODS

A Medline search for GLP-1 receptor agonists (exenatide, liraglutide, lixisenatide, albiglutide, dulaglutide, or semaglutide) was performed, collecting all randomized clinical trials with a duration >11weeks, enrolling patients with type 2 diabetes, and comparing a GLP-1 receptor agonist with placebo or any other non-GLP-1 receptor agonist drug. The principal outcome of this analysis was the effect of GLP-1 receptor agonists on all-cause and cardiovascular mortality, overall (fatal plus nonfatal) myocardial infarction, stroke, and heart failure.

RESULTS

Out of 113 trials fulfilling inclusion criteria (mean duration 41.7±38.2weeks), 32, 25, 48, 43 and 32 reported at least one event for all-cause and cardiovascular mortality, overall (fatal plus nonfatal) myocardial infarction, stroke, and heart failure, respectively. In GLP-1 receptor agonist-treated patients, all-cause mortality, cardiovascular mortality, and myocardial infarction were significantly lower than in comparators (MH-OR [95% CI] 0.88 [0.79-0.97], p=0.015, 0.84 [0.74-0.96], p=0.009, and 0.90 [0.80-1.00], p=0.050, respectively), whereas no beneficial effect was observed for stroke and heart failure (MH-OR [95% CI] 0.90 [0.81-1.00]. p=0.059. 0.89 [0.76-1.04]. p=0.15. and 0.92 [0.81-1.06]. p=0.25. respectively).

CONCLUSIONS

Overall, the agents of this class appear to reduce all-cause mortality, cardiovascular mortality, and the incidence of myocardial infarction at mid-term follow up.

Authors+Show Affiliations

Diabetology, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy. Electronic address: matteo.monami@unifi.it.Diabetology, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy.Diabetology, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy.Diabetology, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy.Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro. Italy.Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro. Italy.Diabetology, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy. Electronic address: edoardo.mannucci@unifi.it.

Pub Type(s)

Journal Article
Meta-Analysis

Language

eng

PubMed ID

28501352

Citation

Monami, Matteo, et al. "Effects of Glucagon-like Peptide-1 Receptor Agonists On Mortality and Cardiovascular Events: a Comprehensive Meta-analysis of Randomized Controlled Trials." International Journal of Cardiology, vol. 240, 2017, pp. 414-421.
Monami M, Zannoni S, Pala L, et al. Effects of glucagon-like peptide-1 receptor agonists on mortality and cardiovascular events: A comprehensive meta-analysis of randomized controlled trials. Int J Cardiol. 2017;240:414-421.
Monami, M., Zannoni, S., Pala, L., Silverii, A., Andreozzi, F., Sesti, G., & Mannucci, E. (2017). Effects of glucagon-like peptide-1 receptor agonists on mortality and cardiovascular events: A comprehensive meta-analysis of randomized controlled trials. International Journal of Cardiology, 240, 414-421. https://doi.org/10.1016/j.ijcard.2017.03.163
Monami M, et al. Effects of Glucagon-like Peptide-1 Receptor Agonists On Mortality and Cardiovascular Events: a Comprehensive Meta-analysis of Randomized Controlled Trials. Int J Cardiol. 2017 Aug 1;240:414-421. PubMed PMID: 28501352.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of glucagon-like peptide-1 receptor agonists on mortality and cardiovascular events: A comprehensive meta-analysis of randomized controlled trials. AU - Monami,Matteo, AU - Zannoni,Stefania, AU - Pala,Laura, AU - Silverii,Antonio, AU - Andreozzi,Francesco, AU - Sesti,Giorgio, AU - Mannucci,Edoardo, Y1 - 2017/05/05/ PY - 2017/01/07/received PY - 2017/03/04/revised PY - 2017/03/29/accepted PY - 2017/5/16/pubmed PY - 2018/3/23/medline PY - 2017/5/15/entrez KW - Cardiovascular events KW - Glucagon-like peptide-1 receptor agonists KW - Metanalysis KW - Mortality SP - 414 EP - 421 JF - International journal of cardiology JO - Int. J. Cardiol. VL - 240 N2 - INTRODUCTION: The publication of the results of LEADER and SUSTAIN-6 trials suggested a possible beneficial effect of the class of GLP-1 receptor agonists on cardiovascular morbidity and mortality. The aim of the present meta-analysis is to collect and synthetize all available evidence on the effect of GLP-1 receptor agonists on cardiovascular events and mortality. METHODS: A Medline search for GLP-1 receptor agonists (exenatide, liraglutide, lixisenatide, albiglutide, dulaglutide, or semaglutide) was performed, collecting all randomized clinical trials with a duration >11weeks, enrolling patients with type 2 diabetes, and comparing a GLP-1 receptor agonist with placebo or any other non-GLP-1 receptor agonist drug. The principal outcome of this analysis was the effect of GLP-1 receptor agonists on all-cause and cardiovascular mortality, overall (fatal plus nonfatal) myocardial infarction, stroke, and heart failure. RESULTS: Out of 113 trials fulfilling inclusion criteria (mean duration 41.7±38.2weeks), 32, 25, 48, 43 and 32 reported at least one event for all-cause and cardiovascular mortality, overall (fatal plus nonfatal) myocardial infarction, stroke, and heart failure, respectively. In GLP-1 receptor agonist-treated patients, all-cause mortality, cardiovascular mortality, and myocardial infarction were significantly lower than in comparators (MH-OR [95% CI] 0.88 [0.79-0.97], p=0.015, 0.84 [0.74-0.96], p=0.009, and 0.90 [0.80-1.00], p=0.050, respectively), whereas no beneficial effect was observed for stroke and heart failure (MH-OR [95% CI] 0.90 [0.81-1.00]. p=0.059. 0.89 [0.76-1.04]. p=0.15. and 0.92 [0.81-1.06]. p=0.25. respectively). CONCLUSIONS: Overall, the agents of this class appear to reduce all-cause mortality, cardiovascular mortality, and the incidence of myocardial infarction at mid-term follow up. SN - 1874-1754 UR - https://www.unboundmedicine.com/medline/citation/28501352/Effects_of_glucagon_like_peptide_1_receptor_agonists_on_mortality_and_cardiovascular_events:_A_comprehensive_meta_analysis_of_randomized_controlled_trials_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0167-5273(17)30131-6 DB - PRIME DP - Unbound Medicine ER -