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Do GLP-1RAs and SGLT-2is reduce cardiovascular events in women with type 2 diabetes? A systematic review and

B M Mishriky1, V Okunrintemi1, S Jain1

  • 1Department of Internal Medicine, East Carolina University, 521 Moye Blvd (2(nd) floor), Greenville NC 27834, United States.

Diabetes & Metabolism
|May 23, 2020
PubMed
Abstract

Insights

Glucagon-like peptide-1 receptor agonists (GLP-1RA) significantly reduce cardiovascular events in women with type 2 diabetes. Sodium-glucose cotransporter-2 inhibitors (SGLT-2i) showed a non-significant reduction, but both drug classes warrant consideration for high-risk women.

Area of Science:

  • Cardiology
  • Endocrinology
  • Pharmacology

Background:

  • Cardiovascular disease (CVD) risk is underestimated in women, delaying crucial interventions.
  • Delayed management of CVD risk factors and medications impacts women's cardiovascular health.
  • Atherosclerotic cardiovascular disease (ASCVD) is a predominant concern in women with type 2 diabetes.

Purpose of the Study:

  • To evaluate the efficacy of glucagon-like peptide-1 receptor agonists (GLP-1RA) and sodium-glucose cotransporter-2 inhibitors (SGLT-2i) in reducing cardiovascular events in women with type 2 diabetes.
  • To analyze the impact of these medications specifically in women with predominant ASCVD.
  • To inform clinical practice regarding the use of GLP-1RA and SGLT-2i in female patients.

Main Methods:

  • Systematic search for randomized controlled trials comparing GLP-1RA or SGLT-2i against placebo.
  • Inclusion criteria: participants with type 2 diabetes and primary outcome of major adverse cardiovascular events (MACE).
  • Focused data extraction on female participants, with sensitivity and subgroup analyses by medication class.

Main Results:

  • Nine trials (6 GLP-1RA, 3 SGLT-2i) involving 84,258 participants (37% women) were analyzed.
  • Pooled analysis revealed a significant reduction in MACE with GLP-1RA or SGLT-2i (RR 0.87 [0.80, 0.94]).
  • Subgroup analysis showed significant MACE reduction with GLP-1RA but not SGLT-2i; SGLT-2i effects require further study.

Conclusions:

  • GLP-1RA significantly decrease MACE in women with type 2 diabetes and ASCVD.
  • SGLT-2i demonstrated a non-significant reduction in MACE, with potential for comparable effects in future research.
  • GLP-1RA and SGLT-2i should be promptly considered for women with type 2 diabetes at increased cardiovascular risk.
Keywords:
CVOTGLP-1 receptor agonistMeta-analysisSGLT-2 inhibitorType 2 diabetesWomen

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