Major cardiovascular events, heart failure, and atrial fibrillation in patients treated with glucagon-like peptide-1 receptor agonists: An updated meta-analysis of randomized controlled trials.

Abstract

BACKGROUND AND AIMS:

Glucagon-like Peptide 1 Receptor Agonists (GLP1-RA) has been associated with a reduction of major cardiovascular events (MACE) and mortality on the basis of the results of cardiovascular outcome trials (CVOT). Several meta-analyses on this issue have been recently published; however, they were all restricted to CVOT, with the exclusion of all studies designed for other endpoints; moreover, other cardiovascular endpoints, such as atrial fibrillation and heart failure have not been fully explored.

METHODS AND RESULTS:

A Medline search for GLP-1 receptor agonists (exenatide, liraglutide, lixisenatide, albiglutide, dulaglutide, or semaglutide) was performed, collecting all randomized clinical trials with a duration ≥52 weeks, enrolling patients with type 2 diabetes, and comparing a GLP-1 receptor agonist with placebo or any other non-GLP-1 receptor agonist drug. We included 43 trials, enrolling 63,134 patients. A significant reduction of MACE (MH-OR 0.87 [0.83, 0.92]), all-cause mortality (MH-OR 0.89 [0.83, 0.96]), and a nonstatistical trend toward reduction of heart failure (MH-OR 0.93 [0.85, 1.01]) was observed - GLP1-RA did not increase the risk of atrial fibrillation (MH-OR 0.94 [0.84, 1.04]).

CONCLUSION:

The present meta-analysis confirms the favorable effects of glucagon-like peptide-1 receptor agonists on major cardiovascular events, cardiovascular and all-cause mortality, stroke, and possibly myocardial infarction. Conversely, the effects on heart failure remain uncertain. Available data on atrial fibrillation seems to exclude any major safety issues in this respect.

REGISTRATION NUMBER (PROSPERO):

CRD42018115577.

• Authors: Besmir Nreu, Ilaria Dicembrini, Federico Tinti, Giorgio Sesti, Edoardo Mannucci, Matteo Monami
• Journal: Nutrition, metabolism, and cardiovascular diseases : NMCD (Nutr Metab Cardiovasc Dis) Vol. 30 Issue 7 Pg. 1106-1114 (06 25 2020) ISSN: 1590-3729 [Electronic] Netherlands
• PMID: 32448716 (Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Systematic Review)
• Copyright: Copyright © 2020 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.

Chemical References

• GLP1R protein, human
• Glucagon-Like Peptide-1 Receptor
• Hypoglycemic Agents
• Incretins

Topics

• Aged
• Atrial Fibrillation (diagnosis, mortality, physiopathology, prevention & control)
• Cause of Death
• Diabetes Mellitus, Type 2 (diagnosis, drug therapy, mortality)
• Female
• Glucagon-Like Peptide-1 Receptor (agonists)
• Heart Failure (diagnosis, mortality, physiopathology, prevention & control)
• Humans
• Hypoglycemic Agents (adverse effects, therapeutic use)
• Incidence
• Incretins (adverse effects, therapeutic use)
• Male
• Middle Aged
• Myocardial Infarction (mortality, physiopathology, prevention & control)
• Protective Factors
• Randomized Controlled Trials as Topic
• Risk Assessment
• Risk Factors
• Treatment Outcome