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

May 26, 2020Nutrition, metabolism, and cardiovascular diseases : NMCD

Heart problems and irregular heartbeat in patients using glucagon-like peptide-1 receptor agonists: Updated analysis of clinical trials

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Abstract

A significant reduction in major cardiovascular events (MACE) was observed with glucagon-like peptide 1 receptor agonists (GLP1-RA), with an odds ratio of 0.87.

GLP1-RA is associated with a reduction in all-cause mortality, with an odds ratio of 0.89.
There is a non-statistical trend toward reduced heart failure risk, indicated by an odds ratio of 0.93.
No increase in the risk of atrial fibrillation was observed, with an odds ratio of 0.94.
The analysis included 43 trials with a total of 63,134 patients, all having a duration of at least 52 weeks.

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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.

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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

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