Glucagon-like peptide-1 receptor agonists and heart failure in type 2 diabetes: systematic review and meta-analysis of randomized and observational studies

BMC Cardiovascular Disorders

Research Article

Ling Li¹  Pujing Zhao¹  Jiali Liu¹  Jiantong Shen¹  Longhao Zhang¹  Xin Sun¹  Shanil Ebrahim²  Jason W. Busse³  Gordon H. Guyatt⁴  Zahra N. Sohani⁵  Sheyu Li⁶  Malgorzata M. Bala⁷  Yingqiang Wang⁸  German Malaga⁹  Evelyn Wong^1,10  Lorena P. Rios^1,11  Per Olav Vandvik^1,12  Qunfei Chen^1,13  Ke Deng^1,14 

[1] Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, 37 GuoXue Xiang, 610041, Chengdu, Sichuan, China;Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada;Department of Anesthesia, McMaster University, Hamilton, ON, Canada;Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, USA;Department of Anaesthesia & Pain Medicine, The Hospital for Sick Children, Toronto, ON, Canada;Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada;Department of Anesthesia, McMaster University, Hamilton, ON, Canada;The Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON, Canada;Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada;Department of Medicine, McMaster University, Hamilton, ON, Canada;Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada;Faculty of Medicine, University of Toronto, 1 King’s College Circle, Toronto, ON, Canada;Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan, China;Department of Hygiene and Dietetics, Jagiellonian University Medical College, Krakow, Poland;Systematic Reviews Unit-Polish Cochrane Branch, Jagiellonian University Medical College, Krakow, Poland;Department of Medical Administration, 363 Hospital, Chengdu, Sichuan, China;Department of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru;Department of Medicine, University of British Columbia, Vancouver, BC, Canada;Internal Medicine Unit, Hospital Clinico FUSAT, Rancagua, Chile;Norwegian Knowledge Centre for the Health Services, Oslo, Norway;Department of Medicine, Innlandet Hospital Trust, Gjøvik, Norway;The Second Hospital of Lanzhou University, Lanzhou, China;West China school of Pharmacy, Sichuan University, Chengdu, Sichuan, China;

关键词: Glucagon-like peptide-1 receptor;    Heart failure;    Type 2 diabetes;    Systematic review;    Meta-analysis;   

DOI  :  10.1186/s12872-016-0260-0

 received in 2016-02-09, accepted in 2016-04-29,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundThe effect of glucagon-like peptide-1(GLP-1) receptor agonists on heart failure remains uncertain. We therefore conducted a systematic review to assess the possible impact of GLP-1 agonists on heart failure or hospitalization for heart failure in patients with type 2 diabetes.MethodsWe searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL) and ClinicalTrials.gov to identify randomized controlled trials (RCTs) and observational studies that addressed the effect of GLP-1 receptor agonists in adults with type 2 diabetes, and explicitly reported heart failure or hospitalization for heart failure. Two paired reviewers screened reports, collected data, and assessed the risk of bias. We pooled data from RCTs and observational studies separately, and used the GRADE approach to rate the quality of evidence.ResultsWe identified 25 studies that were eligible for our review; 21 RCTs (n = 18,270) and 4 observational studies (n = 111,029). Low quality evidence from 20 RCTs suggested, if anything, a lower incidence of heart failure between GLP-1 agonists versus control (17/7,441 vs. 19/4,317; odds ratio (OR) 0.62, 95 % confidence interval (CI) 0.31 to 1.22; risk difference (RD) 19 fewer, 95 % CI 34 fewer to 11 more per 1000 over 5 years). Three cohort studies comparing GLP-1 agonists to alternative agents provided very low quality evidence that GLP-1 agonists do not increase the incidence of heart failure. One RCT provided moderate quality evidence that GLP-1 agonists were not associated with hospitalization for heart failure (lixisenatide vs placebo: 122/3,034 vs. 127/3,034; adjusted hazard ratio 0.96, 95 % CI 0.75 to 1.23; RD 4 fewer, 95 % CI 25 fewer to 23 more per 1000 over 5 years) and a case–control study provided very low quality evidence also suggesting no association (GLP-1 agonists vs. other anti-hyperglycemic drugs: 1118 cases and 17,626 controls, adjusted OR 0.67, 95 % CI 0.32 to 1.42).ConclusionsThe current evidence suggests that GLP-1 agonists do not increase the risk of heart failure or hospitalization for heart failure among patients with type 2 diabetes.

【 授权许可】

CC BY   
© Li et al. 2016