Key result
GLP1RA and SGLT2i reduced major adverse cardiovascular events in T2DM patients with CVD (GLP1RA OR 0.89, 95% CI 0.81-0.97; SGLT2i OR 0.91, 95% CI 0.83-0.99).
Why the study?
To provide an evidence-based basis for selecting cardiovascular benefit drugs in patients with type 2 diabetes mellitus and cardiovascular disease.
Do novel antidiabetic drugs (GLP1RA, SGLT2i, DPP4i) reduce cardiovascular events in patients with T2DM and CVD?
Meta-Analysis (n=172,803)
Do novel antidiabetic drugs (GLP1RA, SGLT2i, DPP4i) reduce cardiovascular events in patients with T2DM and CVD?
Effect estimate: OR 0.89 (GLP1RA); OR 0.91 (SGLT2i) (95% CI 0.81-0.97 (GLP1RA); 0.83-0.99 (SGLT2i))
GLP1RA and SGLT2i significantly reduce MACE, cardiovascular mortality, and all-cause mortality in patients with T2DM and CVD, with SGLT2i uniquely reducing heart failure hospitalizations and GLP1RA uniquely reducing nonfatal stroke.
Supports prioritizing GLP1RA or SGLT2i in T2DM with CVD to lower MACE; confirms RCT benefits in large meta-analysis.
OBJECTIVE: Provide an evidence-based basis for the selection of cardiovascular benefit drugs in Type 2 diabetes mellitus (T2DM) patients with cardiovascular disease (CVD). METHODS: Conduct a comprehensive search of all relevant literature from PubMed, Embase, Web of Science, Cochrane Library, and Clinical Trials.gov from their establishment until December 13, 2023, and select randomized controlled trials (RCTs) that meet the pre-established inclusion and exclusion criteria. Use the Cochrane bias risk assessment tool to evaluate the quality of the included literature. Use R 4.3.2 software to conduct network meta-analysis for drug category comparison. RESULTS: A total of 24 large-scale randomized controlled trials (RCTs) were included, including 19 intervention measures, and 172 803 patients participated in the study. The results of the network meta-analysis show that: GLP1RA (OR 0.89, 95% CI 0.81-0.97) and SGLT2i (OR 0.91, 95% CI 0.83-0.99) can reduce the occurrence of major adverse cardiovascular events (MACE), GLP1RA (OR 0.88, 95% CI 0.79-0.97) and SGLT2i (OR 0.89, 95% CI 0.81-0.99) reduced the risk of cardiovascular death. SGLT2i (OR 0.68, 95% CI 0.62-0.75) reduced the occurrence of hospitalization for heart failure, GLP1RA (OR 0.88, 95% CI 0.81-0.97) and SGLT2i (OR 0.89, 95% CI 0.80-0.97) reduced the occurrence of all-cause death. CONCLUSION: In the comparison of new hypoglycemic drug classes, GLP1RA and SGLT2i reduced MACE, cardiovascular mortality and all-cause mortality in T2DM patients with CVD, with no significant difference in efficacy, and DPP4i was noninferior to placebo. Only GLP1RA reduced the risk of nonfatal stroke, and only SGLT2i reduced the risk of HHF.
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Shi et al. (2025) conducted a meta-analysis in Type 2 diabetes mellitus (T2DM) complicated with cardiovascular disease (CVD) (n=172,803). GLP1RA and SGLT2i vs. Placebo or other antidiabetic drugs was evaluated on Major adverse cardiovascular events (MACE) (OR 0.89 (GLP1RA); OR 0.91 (SGLT2i), 95% CI 0.81-0.97 (GLP1RA); 0.83-0.99 (SGLT2i)). GLP1RA and SGLT2i reduced major adverse cardiovascular events in T2DM patients with CVD (GLP1RA OR 0.89, 95% CI 0.81-0.97; SGLT2i OR 0.91, 95% CI 0.83-0.99).
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