Cardiovascular Outcomes With Glucagon-like Peptide-1 Receptor Agonists In Patients With Type 2 Diabetes:A Meta-analysis

Objective:To evaluate the Cardiovascular outcomes with glucagon-like peptide-1 receptor agonists in patients with type 2 diabetes systematically.Methods:We searched PubMed,Embase,Clinical Trials,Cochrane Library,CNKI and Wan fang database to collecting the literatures on randomized controlled trials(RCTs)of GLP-1RA compared with placebo for type 2 diabetes.Searches were terminated on July,2019.After data extraction and literature quality evaluation,Meta-analysis was performed by using RevMan5.3 software.The experimental group was treated with glucagon-like peptide-1 receptor agonist under conventional treatment,and the control group was treated with placebo under conventional treatment.We conducted publication bias analysis,sensitivity analysis,and heterogeneity analysis,and finally came to a conclusion.Results:1.Seven RCTs,involving 56004 individuals with type 2 diabetes,were included in the analysis,of which 27977 individuals were in the experimental group and 28027 individuals in the control group.Outcome indicators included major adverse cardiovascular events(MACE).MACE included death from cardiovascular causes,non-fatal myocardial infarction,non-fatal stroke.Secondary outcome indicators: All-cause mortality,hospital admission for unstable angina,hospital admission for heart failure.2.In comparisons with placebo,glucagon-like peptide-1 receptor agonist treatment reduced MACE by 12%(OR 0.88,95%CI:0.84-0.93;P<0.00001),ORs were 0.88(95%CI:0.81-0.95;P<0.002)for death from cardiovascular causes,0.83(95%CI:0.73-0.94;P=0.003)for non-fatal stroke,glucagon-like peptide-1 receptor agonist treatment reduced all-cause mortality by 12%(OR 0.88,95%CI:0.83-0.94;P=0.0001),hospital admission for heart failure by 9%(OR 0.91,95%CI:0.83-1.00;P=0.04).There was no statistical difference in the incidence of non-fatal myocardial infarction(OR 0.90,95%CI:0.78-1.04;P=0.15)and in the incidence of hospital admission for unstable angina(OR 1.04,95%CI:0.86-1.24;P=0.71).Conclusion:1.Glucagon-like peptide-1 receptor agonists can reduce MACE,cardiovascular mortality,all-cause mortality,non-fatal stroke and hospitalization due to heart failure in patients with type 2 diabetes.There was no statistical difference between glucagon-like peptide-1 receptor agonist group and placebo group in the incidence of non-fatal myocardial infarction and in the incidence of hospital admission for unstable angina.2.GLP-1RA may have a protective effect on cardiovascular diseases,compared with placebo.