Comparative cardiovascular effectiveness of glucagon-like peptide-1 receptor agonists and sodium–glucose cotransporter-2 inhibitors in atherosclerotic cardiovascular disease phenotypes: a systematic review and meta-analysis

🥉 Top 5% JournalFeb 9, 2025European heart journal. Cardiovascular pharmacotherapy

Comparing heart benefits of two diabetes drug types in different forms of artery disease

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Abstract

A meta-analysis of 26 trials involving 151,789 patients found that both glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT2is) significantly reduced (MACEs) in patients with (ASCVD).

GLP-1 RAs and SGLT2is both resulted in a risk ratio (RR) of 0.85 for reducing MACEs in ASCVD patients.
GLP-1 RAs showed notable effectiveness in reducing MACEs specifically for patients with peripheral artery disease (RR 0.86) and those with post-acute cardiovascular events (RR 0.90).
In patients with heart failure, GLP-1 RAs reduced MACEs significantly (RR 0.73) compared to SGLT2is (RR 0.86).
SGLT2is were particularly effective in reducing MACEs in ASCVD patients with chronic kidney disease (RR 0.84), especially in those with severe albuminuria (RR 0.61).
The differential effectiveness of these drug classes suggests the potential for personalized treatment strategies based on individual ASCVD phenotypes and comorbidities.

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BACKGROUND: (ASCVD) encompasses various phenotypes with elevated risks of (MACEs). This study aimed to assess the comparative cardiovascular effectiveness of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT2is) across diverse ASCVD phenotypes.

METHODS AND RESULTS: We conducted a systematic review and meta-analysis of randomized controlled trials evaluating GLP-1 RAs or SGLT2is against placebo or standard care in ASCVD patients. Primary outcomes included MACE, defined as cardiovascular mortality, non-fatal myocardial infarction, and non-fatal stroke. Risk ratios (RRs) with 95% confidence interval (CI) were calculated using a random-effects model.Twenty-six trials (151 789 patients) were included. Both GLP-1 RAs and SGLT2is significantly reduced MACE rates in ASCVD patients (RR 0.85; 95% CI 0.80-0.91 for both). GLP-1 RAs showed significant effectiveness in peripheral artery disease (RR 0.86; 95% CI 0.76-0.98) and post-acute cardiovascular events (RR 0.90; 95% CI 0.83-0.97). In ASCVD with heart failure, both drug classes reduced MACE (GLP-1 RAs: RR 0.73; 95% CI 0.63-0.84; SGLT2is: RR 0.86; 95% CI 0.78-0.95). SGLT2is significantly reduced MACE in ASCVD with chronic kidney disease (RR 0.84; 95% CI 0.72-0.99), particularly in severe albuminuria (RR 0.61; 95% CI 0.37-0.99).

CONCLUSION: GLP-1 RAs and SGLT2is exhibit distinct cardiovascular effectiveness profiles across ASCVD phenotypes. GLP-1 RAs show particular benefits in peripheral artery disease and post-acute cardiovascular events, while SGLT2is demonstrate unique advantages in ASCVD with comorbid chronic kidney disease. Both are effective in heart failure. These findings support tailored treatment strategies for diverse ASCVD participants based on specific comorbidities and risk factors.

Key numbers

0.85

Reduction Rate

for in patients treated with either drug class.

0.86

Reduction in Peripheral Artery Disease

for in patients with peripheral artery disease treated with .

0.84

Reduction in Chronic Kidney Disease

for in patients with chronic kidney disease treated with .

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Abstract

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