Meta-analyses of results from randomized outcome trials comparing cardiovascular effects of SGLT2i and GLP-1RA in Asian vs. White patients with and without type 2 diabetes

Lee, M. M.Y. , Ghouri, N. , McGuire, D. K., Rutter, M. K. and Sattar, N. (2021) Meta-analyses of results from randomized outcome trials comparing cardiovascular effects of SGLT2i and GLP-1RA in Asian vs. White patients with and without type 2 diabetes. Diabetes Care, 44(5), pp. 1236-1241. (doi: 10.2337/dc20-3007) (PMID:33707305)

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Abstract

BACKGROUND: Results of cardiovascular outcome trials (CVOTs) suggest Asians may derive greater benefit than Whites from newer classes of antihyperglycemic medications. PURPOSE: To provide summary hazard ratio (HR) estimates for cardiovascular efficacy of sodium–glucose cotransporter 2 inhibitors (SGLT2is) and glucagon-like peptide receptor agonists (GLP-1RAs) stratified by race (Asian vs. White). DATA SOURCES: A systematic review performed in PubMed from 1 January 2015 to 8 December 2020. STUDY SELECTION: Randomized placebo-controlled CVOTs of SGLT2is and GLP-1RAs that reported HRs (95% CIs) for 1) major adverse cardiovascular event (MACE) in patients with diabetes and 2) cardiovascular (CV) death/hospitalization for heart failure (HHF) in patients with HF and reduced ejection fraction (HFrEF). DATA EXTRACTION AND SYNTHESIS: HRs (95% CIs) for selected outcomes in Asians and Whites were extracted from each trial, adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Random-effects meta-analyses were performed to examine differences between the selected outcomes in Asians versus Whites. RESULTS: In four SGLT2i trials in type 2 diabetes, the MACE outcome HR (95% CI) in 3,298 Asians versus 20,258 Whites was 0.81 (0.57, 1.04) vs. 0.90 (0.80, 1.00) respectively (Pinteraction = 0.46). In two SGLT2i trials in patients with HFrEF, the CV death/HHF outcome HR in 1,788 Asians versus 5,962 Whites was 0.60 (0.47, 0.74) vs. 0.82 (0.73, 0.92), respectively (Pinteraction = 0.01). In six GLP-1RA trials, the MACE outcome HR in 4,195 Asians versus 37,530 Whites was 0.68 (0.53, 0.84) vs. 0.87 (0.81, 0.94), respectively (Pinteraction = 0.03). LIMITATIONS: Lack of individual patient–level data, relatively short duration of trial observation, and lack of granular categorization of race within broadly defined Asian subgroups. CONCLUSIONS: Compared with Whites, Asians may derive greater CV death/HHF benefit from SGLT2is in patients with HFrEF, and MACE benefit from GLP-1RAs in patients with type 2 diabetes.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Lee, Matthew and Ghouri, Dr Nazim and Sattar, Professor Naveed
Authors: Lee, M. M.Y., Ghouri, N., McGuire, D. K., Rutter, M. K., and Sattar, N.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Journal Name:Diabetes Care
Publisher:American Diabetes Association
ISSN:0149-5992
ISSN (Online):1935-5548
Published Online:11 March 2021
Copyright Holders:Copyright © 2021 American Diabetes Association
First Published:First published in Diabetes Care 44(5): 1236-1241
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
303944BHF Centre of ExcellenceRhian TouyzBritish Heart Foundation (BHF)RE/18/6/34217CAMS - Cardiovascular Science