Effects of antidiabetic drugs on left ventricular function/dysfunction: a systematic review and network meta-analysis

Area of Science:

• Cardiology
• Endocrinology
• Pharmacology

Background:

• Antidiabetic drugs offer cardiovascular protection, but their impact on ventricular remodeling and heart failure progression remains unclear.
• Left ventricular (LV) remodeling is a critical factor in the development of heart failure.
• Identifying antidiabetic agents that improve LV remodeling is crucial for managing patients with type 2 diabetes (T2DM) and/or cardiovascular disease (CVD).

Purpose of the Study:

• To conduct a network meta-analysis comparing the efficacy of various antidiabetic drugs in improving LV remodeling.
• To evaluate sodium glucose cotransporter type 2 (SGLT-2) inhibitors, dipeptidyl peptidase-4 (DPP-4) inhibitors, glucagon-like peptide-1 (GLP-1) agonists, metformin (MET), sulfonylurea (SU), and thiazolidinediones (TZDs).

Main Methods:

• Searched 4 electronic databases (PubMed, EMBASE, Cochrane Library, Web of Science) for studies published before October 18, 2019.
• Included randomized controlled trials and a small number of cohort studies.
• Evaluated mean changes in left ventricular echocardiographic parameters between treatment and control groups.

Main Results:

• GLP-1 agonists significantly improved LV ejection fraction (LVEF) and LV end-systolic volume (LVESV).
• SGLT-2 inhibitors significantly improved LV end-diastolic diameter (LVEDD).
• Both GLP-1 agonists and SGLT-2 inhibitors showed significant improvements in E/e' ratio, indicating better diastolic function.

Conclusions:

• GLP-1 agonists and SGLT-2 inhibitors are associated with improved LV remodeling markers.
• SGLT-2 inhibitors demonstrated superiority over other antidiabetic agents in pairwise comparisons for cardiovascular benefits.
• DPP-4 inhibitors showed a potential negative impact on LV end-diastolic volume (LVEDV).