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Glucagon-like peptide-1 receptor agonists and cardiovascular outcomes in patients with and without prior cardiovascular events: An updated meta-analysis and subgroup analysis of randomized controlled trials.
Diabetes Obes Metab. 2020 02; 22(2):203-211.DO

Abstract

AIM

To conduct a meta-analysis of cardiovascular outcome trials on the effects of glucagon-like peptide-1 receptor agonists (GLP-1RAs) on major adverse cardiovascular events (MACE).

METHODS

A search of MEDLINE, EMBASE, Cochrane database and clinicaltrials.gov was performed to identify controlled trials (up to 15 June 2019) of GLP-1RAs with a cardiovascular endpoint. The principal endpoint of the present meta-analysis was MACE; secondary endpoints included myocardial infarction, stroke, cardiovascular and all-cause mortality, and hospitalization for heart failure. Mantel-Haenszel odds ratios (MH-ORs) with 95% confidence intervals (CIs) were calculated for all outcomes.

RESULTS

In the seven trials included, all placebo-controlled, GLP-1RA treatment was associated with a reduction in MACE (MH-OR 0.87 [95% CI 0.81, 0.93]). Cardiovascular and all-cause mortality, myocardial infarction and stroke were also reduced (MH-OR 0.88 [95% CI 0.80, 0.96], MH-OR 0.90 [95% CI 0.82, 0.98], MH-OR 0.91 [95% CI 0.84, 0.98] and MH-OR 0.86 [95% CI 0.77, 0.97], respectively). Results for hospitalization for heart failure were not statistically significant (MH-OR 0.93 [95% CI 0.83, 1.04]). The meta-analyses of patient subgroups showed a significant reduction in MACE with GLP-1RAs, irrespective of gender, advanced age and obesity.

CONCLUSIONS

GLP-1RAs are associated with a reduction in cardiovascular morbidity and mortality in high-risk patients with diabetes. This effect does not appear to be moderated by gender or body mass index. The possibility of different effects of GLP-1RAs between patients in primary and secondary prevention merits further investigation.

Authors+Show Affiliations

Diabetology, Careggi Hospital and University of Florence, Florence, Italy.Diabetology, Careggi Hospital and University of Florence, Florence, Italy.Diabetology, Careggi Hospital and University of Florence, Florence, Italy.Diabetology, Careggi Hospital and University of Florence, Florence, Italy.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31595657

Citation

Mannucci, Edoardo, et al. "Glucagon-like Peptide-1 Receptor Agonists and Cardiovascular Outcomes in Patients With and Without Prior Cardiovascular Events: an Updated Meta-analysis and Subgroup Analysis of Randomized Controlled Trials." Diabetes, Obesity & Metabolism, vol. 22, no. 2, 2020, pp. 203-211.
Mannucci E, Dicembrini I, Nreu B, et al. Glucagon-like peptide-1 receptor agonists and cardiovascular outcomes in patients with and without prior cardiovascular events: An updated meta-analysis and subgroup analysis of randomized controlled trials. Diabetes Obes Metab. 2020;22(2):203-211.
Mannucci, E., Dicembrini, I., Nreu, B., & Monami, M. (2020). Glucagon-like peptide-1 receptor agonists and cardiovascular outcomes in patients with and without prior cardiovascular events: An updated meta-analysis and subgroup analysis of randomized controlled trials. Diabetes, Obesity & Metabolism, 22(2), 203-211. https://doi.org/10.1111/dom.13888
Mannucci E, et al. Glucagon-like Peptide-1 Receptor Agonists and Cardiovascular Outcomes in Patients With and Without Prior Cardiovascular Events: an Updated Meta-analysis and Subgroup Analysis of Randomized Controlled Trials. Diabetes Obes Metab. 2020;22(2):203-211. PubMed PMID: 31595657.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Glucagon-like peptide-1 receptor agonists and cardiovascular outcomes in patients with and without prior cardiovascular events: An updated meta-analysis and subgroup analysis of randomized controlled trials. AU - Mannucci,Edoardo, AU - Dicembrini,Ilaria, AU - Nreu,Besmir, AU - Monami,Matteo, Y1 - 2019/10/24/ PY - 2019/07/31/received PY - 2019/09/23/revised PY - 2019/09/27/accepted PY - 2019/10/9/pubmed PY - 2019/10/9/medline PY - 2019/10/10/entrez KW - glucagon-like peptide-1 receptor agonists KW - major cardiovascular events KW - meta-analysis KW - mortality SP - 203 EP - 211 JF - Diabetes, obesity & metabolism JO - Diabetes Obes Metab VL - 22 IS - 2 N2 - AIM: To conduct a meta-analysis of cardiovascular outcome trials on the effects of glucagon-like peptide-1 receptor agonists (GLP-1RAs) on major adverse cardiovascular events (MACE). METHODS: A search of MEDLINE, EMBASE, Cochrane database and clinicaltrials.gov was performed to identify controlled trials (up to 15 June 2019) of GLP-1RAs with a cardiovascular endpoint. The principal endpoint of the present meta-analysis was MACE; secondary endpoints included myocardial infarction, stroke, cardiovascular and all-cause mortality, and hospitalization for heart failure. Mantel-Haenszel odds ratios (MH-ORs) with 95% confidence intervals (CIs) were calculated for all outcomes. RESULTS: In the seven trials included, all placebo-controlled, GLP-1RA treatment was associated with a reduction in MACE (MH-OR 0.87 [95% CI 0.81, 0.93]). Cardiovascular and all-cause mortality, myocardial infarction and stroke were also reduced (MH-OR 0.88 [95% CI 0.80, 0.96], MH-OR 0.90 [95% CI 0.82, 0.98], MH-OR 0.91 [95% CI 0.84, 0.98] and MH-OR 0.86 [95% CI 0.77, 0.97], respectively). Results for hospitalization for heart failure were not statistically significant (MH-OR 0.93 [95% CI 0.83, 1.04]). The meta-analyses of patient subgroups showed a significant reduction in MACE with GLP-1RAs, irrespective of gender, advanced age and obesity. CONCLUSIONS: GLP-1RAs are associated with a reduction in cardiovascular morbidity and mortality in high-risk patients with diabetes. This effect does not appear to be moderated by gender or body mass index. The possibility of different effects of GLP-1RAs between patients in primary and secondary prevention merits further investigation. SN - 1463-1326 UR - https://www.unboundmedicine.com/medline/citation/31595657/Glucagon_like_peptide_1_receptor_agonists_and_cardiovascular_outcomes_in_patients_with_and_without_prior_cardiovascular_events:_An_updated_meta_analysis_and_subgroup_analysis_of_randomized_controlled_trials_ L2 - https://doi.org/10.1111/dom.13888 DB - PRIME DP - Unbound Medicine ER -
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