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

Feb 20, 2025Diabetes care

Effectiveness of Glucagon-Like Peptide 1 Drugs on Heart Health in Asian and White People With or Without Type 2 Diabetes or Overweight

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Abstract

GLP-1 receptor agonists are associated with a 0.69 hazard ratio for major adverse cardiovascular events in Asian individuals compared to 0.85 in White individuals.

The analysis included eight randomized placebo-controlled trials with 5,909 Asian and 55,855 White individuals.
In Asian individuals, the absolute risk reduction for major adverse cardiovascular events was 2.9%, compared to 1.4% in White individuals.
There is a statistically significant interaction (Pinteraction = 0.045) suggesting differing cardiovascular benefits by ethnicity.
A lack of individual patient-level data limited detailed subclassification within the Asian group.

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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.

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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

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