Comparative Efficacy of Glucagon-Like Peptide 1 Receptor Agonists for Cardiovascular Outcomes in Asian Versus White Populations: Systematic Review and Meta-analysis of Randomized Trials of Populations With or Without Type 2 Diabetes and/or Overweight or Obesity

Abstract

BACKGROUND Cardiovascular outcome trials (CVOTs) suggest glucagon-like peptide 1 receptor agonists (GLP-1RAs) provide greater cardiovascular (CV) benefits in Asian compared with White individuals. PURPOSE Compare CV efficacy of GLP-1RAs between Asian and White individuals. DATA SOURCES Systematic review of PubMed and ClinicalTrials.gov (1 January 2015 to 1 November 2024). STUDY SELECTION Randomized placebo-controlled CVOTs of GLP-1RAs. Risk of bias was assessed (RoB 2). DATA EXTRACTION Ethnicity-specific hazard ratios (HRs) for major adverse cardiovascular events (MACE). DATA SYNTHESIS Random-effects meta-analyses per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines included eight trials (5,909 Asian individuals, 55,855 White individuals). GLP-1RA–associated MACE HR was 0.69 (95% CI 0.58, 0.83) in Asian people and 0.85 (95% CI 0.79, 0.91) in White people (Pinteraction = 0.045). Absolute MACE risk reduction was 2.9% (95% CI 1.5, 4.2) in Asian people versus 1.4% (0.9, 1.9) in White people. LIMITATIONS Lack of individual patient-level data precluded detailed subclassification of the Asian group. CONCLUSIONS GLP-1RAs may offer greater MACE reductions in Asian compared with White individuals.