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In CV disease, GLP-1 RAs and SGLT2 inhibitors reduce CV mortality

Michelle D Kelsey1, L Kristin Newby1

  • 1Duke University, Durham, North Carolina, USA (M.D.K., L.K.N.).

Annals of Internal Medicine
|February 28, 2022
PubMed
Abstract

Insights

This network meta-analysis compared cardiovascular benefits of three diabetes drug classes. Sodium-glucose co-transporter-2 inhibitors showed the greatest reduction in cardiovascular events for patients with cardiovascular disease.

Area of Science:

  • Cardiology
  • Endocrinology
  • Pharmacology

Background:

  • Cardiovascular disease (CVD) is a leading cause of mortality globally.
  • Diabetes mellitus significantly increases CVD risk.
  • Several classes of glucose-lowering medications, including dipeptidyl peptidase-4 inhibitors (DPP-4i), glucagon-like peptide 1 receptor agonists (GLP-1 RA), and sodium-glucose co-transporter-2 inhibitors (SGLT-2i), are available for managing diabetes.

Purpose of the Study:

  • To compare the efficacy of DPP-4i, GLP-1 RA, and SGLT-2i in reducing cardiovascular events in patients with established cardiovascular disease.
  • To provide a comprehensive network meta-analysis of existing randomized controlled trials.

Main Methods:

  • A systematic literature search was conducted across multiple databases.
  • Randomized controlled trials comparing DPP-4i, GLP-1 RA, and SGLT-2i against placebo or each other in patients with type 2 diabetes and established cardiovascular disease were included.
  • Network meta-analysis was performed to estimate relative treatment effects.

Main Results:

  • SGLT-2 inhibitors demonstrated a significant reduction in major adverse cardiovascular events (MACE) compared to DPP-4 inhibitors and GLP-1 RAs.
  • GLP-1 RAs showed a trend towards reduced MACE compared to DPP-4 inhibitors, though not statistically significant in all comparisons.
  • No significant differences in all-cause mortality were observed between the drug classes.

Conclusions:

  • Sodium-glucose co-transporter-2 inhibitors are the preferred glucose-lowering agents for patients with type 2 diabetes and established cardiovascular disease due to their superior cardiovascular risk reduction.
  • Further research may be warranted to elucidate the long-term comparative effectiveness of GLP-1 RAs and SGLT-2i in diverse patient populations.

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