التفاصيل البيبلوغرافية
| العنوان: |
Cardiovascular protection significantly depends on HbA1c improvement with GLP-1RAs but not with SGLT2 is in type 2 diabetes: A narrative review. |
| المؤلفون: |
Scheen, André J. |
| المصدر: |
Diabetes & Metabolism; Mar2024, Vol. 50 Issue 2, pN.PAG-N.PAG, 1p |
| مصطلحات موضوعية: |
TYPE 2 diabetes, GLUCAGON-like peptide-1 receptor, GLYCOSYLATED hemoglobin, SODIUM-glucose cotransporter 2 inhibitors, CORONARY artery disease |
| مستخلص: |
• Patients with type 2 diabetes are at increased risk of atherosclerotic cardiovascular disease and heart failure. • New antihyperglycaemic agents, both GLP-1RAs and SGLT2is, have proven their efficacy in reducing the risk of cardiovascular complications. • Yet, the specific contribution of HbA1c reduction in the overall better CV prognosis remains unclear with these medications. • Mediation and meta-regression analyses show that the impact of HbA1C reduction is significant for GLP-1RAs, but appears negligible for SGLT2is for both MACEs and heart failure. • The impact of improved glucose control appears predominant for the reduction in ischaemic strokes, especially with GLP-1RAs. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter 2 inhibitors (SGLT2is), while developed as antihyperglycaemic medications for the treatment of type 2 diabetes, have proven to reduce major cardiovascular adverse events (MACEs) and hospitalization for heart failure (especially for SGLT2is) in dedicated cardiovascular outcome trials. The contribution of the glucose-lowering effect in the cardiovascular protection is uncertain and may differ between the two drug classes. This narrative review compares the relative effects of glycated hemoglobin (HbA1c) reduction on the cardiovascular protection provided by GLP-1RAs and SGLT2is in placebo-controlled cardiovascular outcome trials by using the results of either post-hoc mediation analyses or meta-regression studies. Both mediation and meta-regression analyses suggest that the lower cardiovascular risk with GLP-1RAs partially but substantially tracks with their glucose-lowering effect, especially when considering the reduction in nonfatal strokes. In contrast, similar analyses fail to demonstrate any significant contribution of the glucose-lowering effect with SGLT2is, not only on MACEs but also on heart failure issues. The contribution of improved glucose control in cardiovascular protection is limited, but is much greater for GLP-1RAs than for SGLT2is. Of note, such mediation or meta-regression analyses are exploratory and can only be viewed as hypothesis generating. [ABSTRACT FROM AUTHOR] |
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| قاعدة البيانات: |
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