Cardiovascular protection significantly depends on HbA1c improvement with GLP-1RAs but not with SGLT2 is in type 2 diabetes: A narrative review

IF 4.6 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Diabetes & metabolism Pub Date : 2023-12-28 DOI:10.1016/j.diabet.2023.101508
André J. Scheen
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Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.

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对心血管的保护在很大程度上取决于 GLP-1RAs 对 HbA1c 的改善,而不是 SGLT2 对 2 型糖尿病的改善:叙述性综述
背景。-胰高血糖素样肽-1受体激动剂(GLP-1RAs)和钠-葡萄糖共转运体2抑制剂(SGLT2is)虽然是作为治疗2型糖尿病的降血糖药物而开发的,但在专门的心血管结果试验中已被证明可减少主要心血管不良事件(MACEs)和心力衰竭住院(尤其是SGLT2is)。降糖作用对心血管保护的贡献尚不确定,两类药物的降糖作用可能有所不同。-本叙述性综述通过使用事后中介分析或元回归研究的结果,比较了在安慰剂对照的心血管结果试验中,降低糖化血红蛋白(HbA1c)对 GLP-1RAs 和 SGLT2is 提供的心血管保护的相对影响。-中介分析和元回归分析均表明,GLP-1RA 降低心血管风险的效果部分但实质上与其降糖效果一致,尤其是考虑到非致死性中风的减少。与此相反,类似的分析未能证明 SGLT2is 的降糖效果不仅对 MACEs,而且对心力衰竭问题有任何显著贡献。-结论:改善血糖控制对心血管保护的作用有限,但 GLP-1RAs 的作用远大于 SGLT2is。值得注意的是,这种中介或元回归分析是探索性的,只能被视为假设的产生。
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来源期刊
Diabetes & metabolism
Diabetes & metabolism 医学-内分泌学与代谢
CiteScore
12.00
自引率
4.20%
发文量
86
审稿时长
13 days
期刊介绍: A high quality scientific journal with an international readership Official publication of the SFD, Diabetes & Metabolism, publishes high-quality papers by leading teams, forming a close link between hospital and research units. Diabetes & Metabolism is published in English language and is indexed in all major databases with its impact factor constantly progressing. Diabetes & Metabolism contains original articles, short reports and comprehensive reviews.
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