Heterogeneity of antidiabetic treatment effect on the risk of major adverse cardiovascular events in type 2 diabetes: a systematic review and meta-analysis
| العنوان: | Heterogeneity of antidiabetic treatment effect on the risk of major adverse cardiovascular events in type 2 diabetes: a systematic review and meta-analysis |
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| المؤلفون: | Emily H. Jung, Aaron S. Kesselheim, Elvira D’Andrea, Elisabetta Patorno, Spencer Phillips Hey, Jessica M. Franklin |
| المصدر: | Cardiovascular Diabetology, Vol 19, Iss 1, Pp 1-11 (2020) Cardiovascular Diabetology |
| بيانات النشر: | BMC, 2020. |
| سنة النشر: | 2020 |
| مصطلحات موضوعية: | Blood Glucose, medicine.medical_specialty, lcsh:Diseases of the circulatory (Cardiovascular) system, Time Factors, Endocrinology, Diabetes and Metabolism, Comorbidity, Disease, Type 2 diabetes, Glucagon-Like Peptide-1 Receptor, law.invention, Sex Factors, Randomized controlled trial, law, Diabetes mellitus, Internal medicine, Ethnicity, Humans, Hypoglycemic Agents, Medicine, Obesity, Transporter-2 inhibitors, Renal Insufficiency, Chronic, Sodium-glucose co, Sodium-Glucose Transporter 2 Inhibitors, Original Investigation, Proportional Hazards Models, Heart Failure, Mediation Analysis, business.industry, Hazard ratio, Age Factors, Diabetes mellitus, type 2, medicine.disease, Meta-analysis, Cardiovascular diseases, lcsh:RC666-701, Hypertension, Glucagon-like peptide 1 receptor agonists, Cardiology and Cardiovascular Medicine, business, Mace, Kidney disease |
| الوصف: | Background We explored whether clinically relevant baseline characteristics of patients with type 2 diabetes can modify the effect of glucagon-like peptide-1 receptor agonists (GLP-1 RA) or sodium-glucose cotransporter-2 inhibitors (SGLT-2i) on the risk of major adverse cardiovascular events (MACE). Methods We investigated Medline and EMBASE through June 2019. We included randomized clinical trials reporting the effect of GLP-1 RA or SGLT-2i on MACE in subgroups of patients with type 2 diabetes, identified through key baseline factors: established cardiovascular disease; heart failure; chronic kidney disease; uncontrolled diabetes; duration of diabetes; hypertension; obesity; age; gender and race. Hazard ratios (HRs) and 95% confidence intervals (CIs) from trials were meta-analyzed using random-effects models. Results Ten trials enrolling 89,790 patients were included in the analyses. Subgroup meta-analyses showed a 14% risk reduction of MACE in patients with established cardiovascular disease [GLP1-RA: HR, 0.86 (95% CI, 0.80–0.93); SGLT-2i: 0.86 (0.80–0.93)], and no effect in at-risk patients without history of cardiovascular events [GLP1-RA: 0.94 (0.82–1.07); SGLT-2i: 1.00 (0.87–1.16)]. We observed a trend toward larger treatment benefits with SGLT-2i among patients with chronic kidney disease [0.82 (0.69–0.97)], and patients with uncontrolled diabetes for both GLP1-RA or SGLT-2i [GLP1-RA: 0.82 (0.71–0.95); SGLT-2i: 0.84 (0.75–0.95)]. Uncontrolled hypertension, obesity, gender, age and race did not appear to modify the effect of these drugs. Conclusions In this exploratory analysis, history of cardiovascular disease appeared to modify the treatment effect of SGLT2i or GLP1-RA on MACE. Chronic kidney disease and uncontrolled diabetes should be further investigated as potential effect modifiers. |
| اللغة: | English |
| تدمد: | 1475-2840 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::3ed9e06eb53a5594f7a18d44e850e2a1Test http://link.springer.com/article/10.1186/s12933-020-01133-1Test |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....3ed9e06eb53a5594f7a18d44e850e2a1 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 14752840 |
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