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Some glucose-lowering drugs reduce risk for major adverse cardiac events

Aris Liakos1, Apostolos Tsapas1, Eleni Bekiari1

  • 1Aristotle University Thessaloniki, Thessaloniki, Greece (A.L., A.T., E.B.).

Annals of Internal Medicine
|July 21, 2020
PubMed

Insights

This umbrella review maps evidence on glucose-lowering drugs and cardiovascular events. It found that certain medications significantly reduce cardiovascular risks in patients with type 2 diabetes.

Area of Science:

  • Cardiovascular Medicine
  • Endocrinology
  • Pharmacology

Background:

  • Type 2 diabetes is a global health concern associated with increased cardiovascular disease (CVD) risk.
  • Glucose-lowering medications are widely prescribed, but their comparative effects on cardiovascular outcomes require comprehensive evaluation.
  • An evidence map is crucial for understanding the landscape of research on these drug classes and their cardiovascular impact.

Purpose of the Study:

  • To conduct an umbrella review and create an evidence map of randomized controlled trials evaluating glucose-lowering medications for cardiovascular outcomes.
  • To synthesize and visualize the existing evidence on the association between different classes of glucose-lowering drugs and major adverse cardiovascular events (MACE).
  • To identify research gaps and guide future clinical practice and research directions in diabetes management.

Main Methods:

  • Systematic search of multiple electronic databases for relevant randomized controlled trials (RCTs).
  • Umbrella review methodology to synthesize evidence from existing systematic reviews and meta-analyses.
  • Evidence mapping to categorize studies by drug class, patient population, and reported cardiovascular outcomes.

Main Results:

  • Sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA) demonstrated significant reductions in major adverse cardiovascular events (MACE).
  • Other drug classes showed varying effects, with some lacking robust evidence for cardiovascular benefit or showing potential harm.
  • The evidence map highlighted a substantial body of research for certain drug classes, while others had limited data.

Conclusions:

  • SGLT2 inhibitors and GLP-1 receptor agonists are recommended for patients with type 2 diabetes at high cardiovascular risk due to proven benefits.
  • The choice of glucose-lowering medication should consider individual patient profiles, comorbidities, and cardiovascular risk factors.
  • Further research is needed to clarify the cardiovascular effects of less-studied glucose-lowering agents.
Abstract

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