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Major cardiovascular events, heart failure, and atrial fibrillation in patients treated with glucagon-like peptide-1 receptor agonists: An updated meta-analysis of randomized controlled trials.
Nutr Metab Cardiovasc Dis. 2020 Jun 25; 30(7):1106-1114.NM

Abstract

BACKGROUND AND AIMS

Glucagon-like Peptide 1 Receptor Agonists (GLP1-RA) has been associated with a reduction of major cardiovascular events (MACE) and mortality on the basis of the results of cardiovascular outcome trials (CVOT). Several meta-analyses on this issue have been recently published; however, they were all restricted to CVOT, with the exclusion of all studies designed for other endpoints; moreover, other cardiovascular endpoints, such as atrial fibrillation and heart failure have not been fully explored.

METHODS AND RESULTS

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 ≥52 weeks, enrolling patients with type 2 diabetes, and comparing a GLP-1 receptor agonist with placebo or any other non-GLP-1 receptor agonist drug. We included 43 trials, enrolling 63,134 patients. A significant reduction of MACE (MH-OR 0.87 [0.83, 0.92]), all-cause mortality (MH-OR 0.89 [0.83, 0.96]), and a nonstatistical trend toward reduction of heart failure (MH-OR 0.93 [0.85, 1.01]) was observed - GLP1-RA did not increase the risk of atrial fibrillation (MH-OR 0.94 [0.84, 1.04]).

CONCLUSION

The present meta-analysis confirms the favorable effects of glucagon-like peptide-1 receptor agonists on major cardiovascular events, cardiovascular and all-cause mortality, stroke, and possibly myocardial infarction. Conversely, the effects on heart failure remain uncertain. Available data on atrial fibrillation seems to exclude any major safety issues in this respect.

REGISTRATION NUMBER (PROSPERO)

CRD42018115577.

Authors+Show Affiliations

Diabetology, Careggi Hospital and University of Florence, Italy.Diabetology, Careggi Hospital and University of Florence, Italy.Diabetology, Careggi Hospital and University of Florence, Italy.Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology of the Sapienza University of Rome, Rome, Italy.Diabetology, Careggi Hospital and University of Florence, Italy.Diabetology, Careggi Hospital and University of Florence, Italy. Electronic address: matteo.monami@unifi.it.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32448716

Citation

Nreu, Besmir, et al. "Major Cardiovascular Events, Heart Failure, and Atrial Fibrillation in Patients Treated With Glucagon-like Peptide-1 Receptor Agonists: an Updated Meta-analysis of Randomized Controlled Trials." Nutrition, Metabolism, and Cardiovascular Diseases : NMCD, vol. 30, no. 7, 2020, pp. 1106-1114.
Nreu B, Dicembrini I, Tinti F, et al. Major cardiovascular events, heart failure, and atrial fibrillation in patients treated with glucagon-like peptide-1 receptor agonists: An updated meta-analysis of randomized controlled trials. Nutr Metab Cardiovasc Dis. 2020;30(7):1106-1114.
Nreu, B., Dicembrini, I., Tinti, F., Sesti, G., Mannucci, E., & Monami, M. (2020). Major cardiovascular events, heart failure, and atrial fibrillation in patients treated with glucagon-like peptide-1 receptor agonists: An updated meta-analysis of randomized controlled trials. Nutrition, Metabolism, and Cardiovascular Diseases : NMCD, 30(7), 1106-1114. https://doi.org/10.1016/j.numecd.2020.03.013
Nreu B, et al. Major Cardiovascular Events, Heart Failure, and Atrial Fibrillation in Patients Treated With Glucagon-like Peptide-1 Receptor Agonists: an Updated Meta-analysis of Randomized Controlled Trials. Nutr Metab Cardiovasc Dis. 2020 Jun 25;30(7):1106-1114. PubMed PMID: 32448716.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Major cardiovascular events, heart failure, and atrial fibrillation in patients treated with glucagon-like peptide-1 receptor agonists: An updated meta-analysis of randomized controlled trials. AU - Nreu,Besmir, AU - Dicembrini,Ilaria, AU - Tinti,Federico, AU - Sesti,Giorgio, AU - Mannucci,Edoardo, AU - Monami,Matteo, Y1 - 2020/03/25/ PY - 2020/01/21/received PY - 2020/03/13/revised PY - 2020/03/14/accepted PY - 2020/5/26/pubmed PY - 2020/5/26/medline PY - 2020/5/26/entrez KW - All-cause mortality KW - Atrial fibrillation KW - Glucagon-like peptide-1 receptor agonists KW - Heart failure KW - Major amputations KW - Major cardiovascular events KW - Meta-analysis SP - 1106 EP - 1114 JF - Nutrition, metabolism, and cardiovascular diseases : NMCD JO - Nutr Metab Cardiovasc Dis VL - 30 IS - 7 N2 - BACKGROUND AND AIMS: Glucagon-like Peptide 1 Receptor Agonists (GLP1-RA) has been associated with a reduction of major cardiovascular events (MACE) and mortality on the basis of the results of cardiovascular outcome trials (CVOT). Several meta-analyses on this issue have been recently published; however, they were all restricted to CVOT, with the exclusion of all studies designed for other endpoints; moreover, other cardiovascular endpoints, such as atrial fibrillation and heart failure have not been fully explored. METHODS AND RESULTS: 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 ≥52 weeks, enrolling patients with type 2 diabetes, and comparing a GLP-1 receptor agonist with placebo or any other non-GLP-1 receptor agonist drug. We included 43 trials, enrolling 63,134 patients. A significant reduction of MACE (MH-OR 0.87 [0.83, 0.92]), all-cause mortality (MH-OR 0.89 [0.83, 0.96]), and a nonstatistical trend toward reduction of heart failure (MH-OR 0.93 [0.85, 1.01]) was observed - GLP1-RA did not increase the risk of atrial fibrillation (MH-OR 0.94 [0.84, 1.04]). CONCLUSION: The present meta-analysis confirms the favorable effects of glucagon-like peptide-1 receptor agonists on major cardiovascular events, cardiovascular and all-cause mortality, stroke, and possibly myocardial infarction. Conversely, the effects on heart failure remain uncertain. Available data on atrial fibrillation seems to exclude any major safety issues in this respect. REGISTRATION NUMBER (PROSPERO): CRD42018115577. SN - 1590-3729 UR - https://www.unboundmedicine.com/medline/citation/32448716/Major_cardiovascular_events,_heart_failure,_and_atrial_fibrillation_in_patients_treated_with_glucagon-like_peptide-1_receptor_agonists:_An_updated_meta-analysis_of_randomized_controlled_trials L2 - https://linkinghub.elsevier.com/retrieve/pii/S0939-4753(20)30095-8 DB - PRIME DP - Unbound Medicine ER -
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