Do GLP-1RAs and SGLT-2is reduce cardiovascular events in women with type 2 diabetes? A systematic review and meta-analysis

May 23, 2020Diabetes & metabolism

Do GLP-1 and SGLT-2 medications lower heart risks in women with type 2 diabetes? A review and combined analysis

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Abstract

Of the 84,258 participants in the trials, 30,784 (37%) were women.

Pooled results indicate a statistically significant lower incidence of major adverse cardiovascular events (MACE) with diabetes medications compared to placebo (RR [95%CI]=0.87 [0.80, 0.94]).
GLP-1 receptor agonist (GLP-1RA) medications showed a significant reduction in MACE, while sodium-glucose cotransporter-2 inhibitors (SGLT-2i) did not demonstrate a significant reduction.
The findings suggest that GLP-1RA may be particularly beneficial for women with type 2 diabetes who have elevated cardiovascular risk or established cardiovascular disease.
SGLT-2i may have comparable effects on MACE, but further studies are required to confirm this.

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AIMS: The risk of cardiovascular disease is often underestimated in women. This leads to a delay in controlling the risk factors for cardiovascular disease and even delays in prescribing medications with cardiovascular benefit. Our aim was to explore if glucagon-like peptide-1 receptor agonist (GLP-1RA) or sodium-glucose cotransporter-2 inhibitor (SGLT-2i) medications would reduce cardiovascular events in women with type 2 diabetes when atherosclerotic cardiovascular disease (ASCVD) predominates.

MATERIALS AND METHODS: We searched for randomized trials comparing GLP-1RA or SGLT-2i to placebo in people with type 2 diabetes and had a primary outcome exploring major adverse cardiovascular events (MACE). Data concerning women were then extracted. A sensitivity and subgroup analyses were performed according to the class of diabetes medication.

RESULTS: A total of 9 trials (GLP-1RA in 6 trials and SGLT-2i in 3) were included. Of the 84,258 participants enrolled, 30,784 (37%) participants were women. Pooled results showed a statistically significant lower incidence of MACE favouring diabetes medications (GLP-1RA or SGLT-2i) compared to placebo (RR [95%CI]=0.87 [0.80, 0.94]). On restricting the analysis to GLP-1RA then to SGLT-2i, results remained significant with GLP-1RA but not SGLT-2i.

CONCLUSIONS: In women with type 2 diabetes who either have increased cardiovascular risk or established cardiovascular disease and ASCVD predominates, GLP-1RA significantly reduce the incidence of MACE while SGLT-2i result in a non-significant reduction. SGLT-2i may have comparable effect when examined in more studies. GLP-1RA and SGLT-2i should be considered without delay in women with type 2 diabetes and increased risk for cardiovascular disease.

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Do GLP-1RAs and SGLT-2is reduce cardiovascular events in women with type 2 diabetes? A systematic review and meta-analysis

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