Asian Subpopulations May Exhibit Greater Cardiovascular Benefit from Long-Acting Glucagon-Like Peptide 1 Receptor Agonists: A Meta-Analysis of Cardiovascular Outcome Trials

Diabetes & Metabolism Journal

卷:43

Ye-Jee Kim¹  Seung Eun Lee²  Joong-Yeol Park²  Chang Hee Jung²  Jiwoo Lee²  Woo Je Lee²  Yun Kyung Cho²  Michael A. Nauck³  Yu Mi Kang⁴ 

[1] Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, .Korea;

[2] Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, .Korea;

[3] Diabetes Center Bochum-Hattingen, St. Josef-Hospital, Ruhr-University Bochum, Bochum, .Germany;

[4] International Healthcare Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, .Korea;

关键词: agonist;    cardiovascular disease;    diabetes mellitus, type 2;    glucagon-like peptide 1;    incretins;    meta-analysis;    safety;    therapeutics;   

DOI  :  10.4093/dmj.2018.0070

来源: DOAJ

【 摘 要 】

BackgroundBased on reported results of three large cardiovascular outcome trials (CVOTs) of glucagon-like peptide 1 receptor agonists (GLP-1 RAs), we aimed to investigate the overall effect of GLP-1 RAs on major adverse cardiovascular events (MACEs) and to identify subpopulations exhibiting the greatest cardiovascular (CV) benefit.MethodsThree CVOTs reporting effects of long-acting GLP-1 RAs were included: LEADER (liraglutide), SUSTAIN-6 (semaglutide), and EXSCEL (exenatide once weekly). In all studies, the primary endpoint was three-point MACE, comprising CV death, non-fatal myocardial infarction, and non-fatal stroke. Overall effect estimates were calculated as hazard ratios and 95% confidence intervals (CIs) using the random-effects model; subgroup analyses reported in the original studies were similarly analyzed.ResultsOverall, statistically significant risk reductions in MACE and CV death were observed. Subgroup analysis indicated a significant racial difference with respect to CV benefit (P for interaction <0.001), and more substantial risk reductions were observed in subjects of African origin (relative risk [RR], 0.78; 95% CI, 0.60 to 0.99) and in Asians (RR, 0.35; 95% CI, 0.09 to 1.32). However, post hoc analysis (Bonferroni method) revealed that only Asians exhibited a significantly greater CV benefit from treatment, compared with white subjects (P<0.0001).ConclusionLong-acting GLP-1 RAs reduced risks of MACE and CV deaths in high-risk patients with type 2 diabetes mellitus. Our findings of a particularly effective reduction in CV events with GLP-1 RA in Asian populations merits further exploration and dedicated trials in specific populations.

【 授权许可】

Unknown