Effects of glucagon‐like peptide‐1 receptor agonists on major coronary events in patients with type 2 diabetes

Aims To perform a meta‐analysis to assess the effects of glucagon‐like peptide‐1 receptor agonists (GLP‐1RAs) on major coronary events, including myocardial infarction (MI), unstable angina and coronary revascularization, in patients with type 2 diabetes mellitus (T2DM). Materials and methods We systematically searched the PubMed, CENTRAL, EMBASE and clinicaltrial.gov databases to seek eligible studies with a cardiovascular endpoint comparing GLP‐1RAs with a placebo in T2DM patients. Odds ratio (ORs) and 95% confidence intervals (CIs) were calculated for the outcomes. Results Nine studies, with a total of 64 236 patients, were included. GLP‐1RA treatment reduced fatal and nonfatal MI by 8% (OR 0.92, 95% CI 0.86–0.99; P = 0.02, I 2 = 39%). The reduction reached 15% in human‐based GLP‐1RA‐treated patients. Similarly, once‐weekly GLP‐1RA treatment reduced the risk of MI by 13%. In contrast, GLP‐1RA treatment did not reduce the risk of hospitalization for unstable angina (OR 1.11, 95% CI 0.97–1.28; P = 0.13, I 2 = 21%). GLP‐1RAs exhibited a tendency to lower the risk of coronary revascularization (OR 0.95, 95% CI 0.89–1.02; P = 0.15, I 2 = 22%), but without statistical significance. Human‐based GLP‐1RAs decreased the risk by 11%. Conclusions In high‐risk patients with T2DM, GLP‐1RAs were associated with a decrease in MI, especially the human‐based and once‐weekly GLP‐1RAs. No benefit was seen for hospitalization for unstable angina or coronary revascularization. Further research is urgently needed to ascertain improvements in coronary events.