Effects of GLP-1 receptor agonists on arrhythmias and its subtypes in patients with type 2 diabetes: A systematic review and meta-analysis

Q: What is the clinical evidence from this study?

Study design: Systematic Review. Population: Type 2 Diabetes (n=60081). Intervention: GLP-1 receptor agonists vs. placebo. Primary outcome: Total arrhythmias (RR 0.96, 95% CI 0.87-1.05, p=0.36).

Q: What does this research mean for the field?

Treatment with GLP-1 receptor agonists has no significant effect on the risk of total arrhythmias in patients with type 2 diabetes compared to placebo. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

Jinjing Wei; Ruxin Wang; Haowen Ye; Ying Wang; Lihong Wang; Xiaofang Zhang

doi:10.3389/fendo.2022.910256

August 11, 2022Frontiers in EndocrinologyOpen Access

Effects of GLP-1 receptor agonists on arrhythmias and its subtypes in patients with type 2 diabetes: A systematic review and meta-analysis

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Key result

GLP-1 receptor agonists show no benefit over placebo for total arrhythmias.

RR 0.96
95% CI 0.87-1.05
P=0.36
n=60,081

Figures

Why the study?

To update a systematic review and meta-analysis assessing the risk of arrhythmias and their subtypes in type 2 diabetic patients receiving GLP-1RA therapy based on cardiovascular outcome trial data.

Does GLP-1RA treatment reduce the risk of arrhythmias in patients with type 2 diabetes?

Study Design

Type

Systematic Review (n=60,081)

Blinding

null

Randomization

null

Multicenter

Yes

Structured PICO

Does GLP-1RA treatment reduce the risk of arrhythmias in patients with type 2 diabetes?

P

Population

60,081 patients with type 2 diabetes mellitus at high cardiovascular risk pooled from 8 randomized controlled cardiovascular outcome trials.

I

Intervention

GLP-1 receptor agonists (GLP-1RA) as a class

C

Comparator

Placebo

O

Outcome

Total arrhythmias and major arrhythmia types (atrial fibrillation, atrial flutter, ventricular fibrillation, ventricular tachycardia, atrial tachycardia, sinus node dysfunction, ventricular preterm systole, second degree AV block, complete AV block)safety

Main Result

Effect estimate: RR 0.96 (95% CI 0.87-1.05)

p-value: p=0.36

In patients with type 2 diabetes, GLP-1 receptor agonists do not significantly affect the risk of major arrhythmias but significantly reduce the risk of hypoglycemia and pneumonia.

Limitations

Several trials included had different designs and focused on general cardiovascular outcomes rather than specifically on arrhythmias.
Follow-up periods were relatively short in the context of long-term arrhythmic risk assessment.
No head-to-head comparisons of different GLP-1RA drugs were available.
Lack of data on the origin of the patients limited further subgroup analysis

Implication

GLP-1RAs show arrhythmia neutrality in type 2 diabetes; extends RCT meta-analysis evidence supporting overall cardiovascular safety.

Abstract

Purpose An update of a systematic review and meta-analysis of the risk of arrhythmias and their subtypes in type 2 diabetic patients receiving glucagon-like peptide 1 receptor agonist (GLP-1RA) medication according to data from the Cardiovascular Outcome Trial(CVOT). Methods Randomized controlled trials (RCT) on GLP-1RA therapy and cardiovascular outcomes in type 2 diabetes mellitus patients published in full-text journal databases such as MEDLINE (via PubMed), Embase, Clinical Trials.gov, and the Cochrane Library from establishment to March 1, 2022 were searched. We assessed the quality of individual studies by the Cochrane risk-of-bias algorithm. RevMan 5.4.1 software was use for calculating meta-analysis. Results A total of 60,081 randomized participants were included in the data of these 8 GLP-1RA cardiovascular outcomes trials. Pooled analysis reported no significant effect on total arrhythmia [RR=0.96, 95% CI (0.96, 1.05), p =0.36], and its subtypes such as atrial fibrillation [RR=0.96, 95% CI (0.86, 1.07), p =0.43], atrial flutter [RR= 0.82, 95% CI (0.57, 1.19), p =0.30], atrial tachycardia [RR=0.64, 95% CI (0.20, 2.01), p =0.44)], sinoatrial node dysfunction [RR=0.74, 95% CI (0.44, 1.25), p =0.26], ventricular preterm systole [RR=1.42, 95% CI (0.62, 3.26), p =0.41], second degree AV block [RR=0.96, 95% CI (0.53, 1.72), p =0.88], complete AV block [RR=0.75, 95% CI (0.49, 1.17), p =0.21], ventricular fibrillation [RR=1.00, 95% CI (0.50, 2.02), p =1.00], ventricular tachycardia [RR=1.37, 95% CI (0.91, 2.08), p =0.13] from treatment with GLP-1RA versus placebo. However, the risk of hypoglycemia was reduced by about 30% [RR=0.70, 95% CI (0.57, 0.87), p =0.001] and the risk of pneumonia by about 25% [RR=0.85, 95% CI (0.75, 0.97), p =0.01], both statistically significant differences. Conclusion In type 2 diabetic patients, treatment with GLP-1RA has no significant effect on the risk of major arrhythmias but significantly reduces the risk of hypoglycemia and pneumonia.

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Cite This Study

Wei et al. (2022) conducted a systematic review in Type 2 Diabetes (n=60,081). GLP-1 receptor agonists vs. placebo was evaluated on Total arrhythmias (RR 0.96, 95% CI 0.87-1.05, p=0.36). Treatment with GLP-1 receptor agonists had no significant effect on total arrhythmias compared to placebo (RR 0.96).

synapsesocial.com/papers/6967d44bc59c9a05920964ae https://doi.org/10.3389/fendo.2022.910256