Incretin-based agents overall had no significant effect on cardiovascular outcomes compared to placebo, although subgroup analysis revealed that GLP-1 agonists significantly reduced all-cause mortality (RR 0.90) and cardiovascular mortality (RR 0.84).
Meta-Analysis (n=55,248)
Yes
Do incretin-based agents (GLP-1 agonists and DPP-4 inhibitors) reduce cardiovascular and pancreatic outcomes in patients with type 2 diabetes mellitus and high cardiovascular risk?
In patients with type 2 diabetes at high cardiovascular risk, GLP-1 agonists decrease all-cause and cardiovascular mortality, whereas DPP-4 inhibitors do not improve cardiovascular outcomes and increase the risk of acute pancreatitis.
Relative Risk: 0.97 (95% CI 0.89–1.06)
BACKGROUND: Incretin-based agents, including dipeptidyl peptidase-4 inhibitors (DPP-4Is) and glucagon-like peptide-1 agonists (GLP-1As), work via GLP-1 receptor for hyperglycemic control directly or indirectly, but have different effect on cardiovascular (CV) outcomes. The present study is to evaluate and compare effects of incretin-based agents on CV and pancreatic outcomes in patients with type 2 diabetes mellitus (T2DM) and high CV risk. METHODS: Six prospective randomized controlled trials (EXMAINE, SAVOR-TIMI53, TECOS, ELIXA, LEADER and SUSTAIN-6), which included three trials for DPP-4Is and three trials for GLP-1As, with 55,248 participants were selected to assess the effect of different categories of incretin-based agents on death, CV outcomes (CV mortality, major adverse CV events, nonfatal myocardial infarction, nonfatal stroke, heart failure hospitalization), pancreatic events (acute pancreatitis and pancreatic cancer) as well as on hypoglycemia. RESULTS: When we evaluated the combined effect of six trials, the results suggested that incretin-based treatment had no significant effect on overall risks of CV and pancreatic outcomes compared with placebo. However, GLP-1As reduced all-cause death (RR = 0.90, 95% CI 0.82-0.98) and CV mortality (RR = 0.84, 95% CI 0.73-0.97), whereas DPP-4Is had no significant effect on CV outcomes but elevated the risk for acute pancreatitis (OR = 1.76, 95% CI 1.14-2.72) and hypoglycemia (both any and severe hypoglycemia), while GLP-1As lowered the risk of severe hypoglycemia. CONCLUSIONS: GLP-1As decreased risks of all-cause and CV mortality and severe hypoglycemia, whereas DPP-4Is had no effect on CV outcomes but increased risks in acute pancreatitis and hypoglycemia.
Zhang et al. (2017) conducted a meta-analysis in Type 2 diabetes mellitus with high cardiovascular risk (n=55,248). Incretin-based agents (GLP-1 agonists and DPP-4 inhibitors) vs. Placebo was evaluated on All-cause mortality (RR 0.97, 95% CI 0.89-1.06). Incretin-based agents overall had no significant effect on cardiovascular outcomes compared to placebo, although subgroup analysis revealed that GLP-1 agonists significantly reduced all-cause mortality (RR 0.90) and cardiovascular mortality (RR 0.84).