Combining GLP-1 receptor agonists and SGLT-2 inhibitors for cardiovascular disease prevention in type 2 diabetes:A systematic review with multiple network meta-regressions  

作　　者：Jing-Jing Zhu John P H Wilding Xiao-Song Gu 

机构地区：[1]Department of Endocrinology and Metabolic Medicine,The Second Affiliated Hospital of Soochow University,Suzhou 215004,Jiangsu Province,China [2]Department of Cardiovascular and Metabolic Medicine,University of Liverpool,Liverpool L697ZX,United Kingdom [3]Clinical Sciences Centre,Liverpool University Hospitals NHS Foundation Trust,Liverpool L97AL,United Kingdom [4]Department of Cardiovascular Medicine,The Second Affiliated Hospital of Soochow University,Suzhou 215004,Jiangsu Province,China

出　　处：《World Journal of Diabetes》2024年第10期2135-2146,共12页世界糖尿病杂志（英文）

基　　金：Supported by China Scholarship Council,No.202006920018;Key Talent Program for Medical Applications of Nuclear Technology,No.XKTJ-HRC2021007;the Second Affiliated Hospital of Soochow University,No.SDFEYBS1815 and No.SDFEYBS2008;National Natural Science Foundation of China,No.82170831;The Jiangsu Innovation&Career Fund for PhD 2019.

摘　　要：BACKGROUND Glucagon-like peptide-1 receptor agonists(GLP-1RA)and sodium-glucose co-transporter-2 inhibitors(SGLT-2I)are associated with significant cardiovascular benefit in type 2 diabetes(T2D).However,GLP-1RA or SGLT-2I alone may not improve some cardiovascular outcomes in patients with prior cardiovascular co-morbidities.AIM To explore whether combining GLP-1RA and SGLT-2I can achieve additional benefit in preventing cardiovascular diseases in T2D.METHODS The systematic review was conducted according to PRISMA recommendations.The protocol was registered on PROSPERO(ID:42022385007).A total of 107049 participants from eligible cardiovascular outcomes trials of GLP-1RA and SGLT-2I were included in network meta-regressions to estimate cardiovascular benefit of the combination treatment.Effect modification of prior myocardial infarction(MI)and heart failure(HF)was also explored to provide clinical insight as to when the INTRODUCTION The macro-and micro-vascular benefits of glucagon-like peptide-1 receptor agonists(GLP-1RA)and sodium-glucose co-transporter-2 inhibitors(SGLT-2I)are independent of their glucose-lowering effects[1].In patients with type 2 diabetes(T2D),the major cardiovascular outcome trials(CVOT)showed that dipeptidyl peptidase-4 inhibitors(DPP-4I)did not improve cardiovascular outcomes[2],whereas cardiovascular benefit of GLP-1RA or SGLT-2I was significant[3,4].Further subgroup analyses indicated that the background cardiovascular risk should be considered when examining the cardiovascular outcomes of these newer glucose-lowering medications.For instance,prevention of major adverse cardiovascular events(MACE)was only seen in those patients with baseline atherosclerotic cardiovascular disease[3,4].Moreover,a series of CVOT conducted in patients with heart failure(HF)have demonstrated that(compared with placebo)SGLT-2I significantly reduced risk of hospitalization for HF or cardiovascular death,irrespective of their history of T2D[5-8].However,similar cardiovascular benefits were not observed in those

关 键 词：Type 2 diabetes Glucagon-like peptide-1 receptor agonist Sodium-glucose co-transporter-2 inhibitor Combination treatment Cardiovascular outcome Systematic review Network meta-regression 

分 类 号：R587.1[医药卫生—内分泌]