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Association between intensity of glycemic control with GLP-1 receptor agonists and risk of atherosclerotic cardiovascular disease: a systematic review and meta-regression
Session:
Posters (Sessão 1 - Écran 8) - Dislipidémia, Diabetes e Obesidade
Speaker:
Daniel A. Gomes
Congress:
CPC 2023
Topic:
J. Preventive Cardiology
Theme:
28. Risk Factors and Prevention
Subtheme:
28.7 Diabetes and the Heart
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Daniel A. Gomes; João Presume; Jorge Ferreira; Pedro de Araújo Gonçalves; Manuel Sousa Almeida; Miguel Mendes
Abstract
<p><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt"><strong><span style="color:black">Background: </span></strong></span></span></p> <p><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt"><span style="color:black">Several g</span><span style="color:black">lucagon-like peptide-1</span><span style="background-color:white"><span style="color:black"> receptor agonists (GLP-1 RAs) have shown to reduce major adverse cardiovascular events (MACE) in patients with type 2 diabetes mellitus (DM). However, this reduction has not been consistent among different GLP-1 RAs. We conducted a systematic review and meta-regression analyses </span></span><span style="color:black">to evaluate the association between the intensity of glycemic control achieved by GLP-1 RAs therapy in patients with type 2 DM and the reduction of MACE as well as to identify potential mechanisms involved.</span></span></span></p> <p> </p> <p><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt"><strong><span style="color:black">Methods: </span></strong></span></span></p> <p><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt"><span style="color:black">Electronic databases (MEDLINE, CENTRAL, SCOPUS) were searched through November 2022.</span> <span style="color:black">Studies were considered eligible if they were cardiovascular outcomes randomized trials (CVOTs) comparing GLP-1 RAs versus placebo in type 2 DM patients. Trials including non-diabetic patients</span> <span style="color:black">and GLP-1 RAs refused by European Medicines Agency or <span style="background-color:white">US Food and Drug Administration were excluded</span></span>. <span style="color:black">The outcome of interest was 3-point MACE (CV death, MI, or stroke). Random-effects meta-analyses and meta-regression evaluated associations between glycemic control with GLP-1 RAs and study outcomes. Secondary meta-regression analyses were performed for body weight and blood pressure (BP) variation. </span></span></span></p> <p> </p> <p><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt"><strong><span style="color:black">Results: </span></strong></span></span></p> <p><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt">Overall, 8 CVOTs were included, with a total of 60080 patients (30694 treated with GLP-1 RAs). GLP-1 RAs were associated with a lower incidence of 3P-MACE (RR 0.876; 95% CI 0.821-0.935, p<0.001). Mean HbA<sub>1C</sub> reduction was 0.57% in patients treated with GLP-1 RAs vs. placebo. Meta-regression showed that higher reductions of HbA<sub>1C</sub> levels were associated with lower risk of 3P-MACE (Log RR -0.286 [95% CI -0.512; -0.056], p=0.015), which translates into an estimated relative risk reduction of 25% for each 1% reduction in HbA<sub>1C</sub> (<strong><span style="color:#0070c0">Figure 1A</span></strong>). There was a non-significant association between glycemic control and each of the 3P-MACE outcomes analyzed separately. Body weight reduction was also associated with a lower risk of 3P-MACE (Log RR -0.067 [95% CI -0.134; 0.001], p=0.053), despite not meeting statistical significance (<strong><span style="color:#0070c0">Figure 1B</span></strong>). Systolic BP decrease was not associated with reduced risk of 3P-MACE.</span></span></p> <p> </p> <p><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt"><strong><span style="color:black">Conclusions:</span></strong> </span></span></p> <p><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt">T<span style="color:black">he better the glycemic control with GLP-1 RAs in type 2 DM patients, the greater the reduction in 3P-MACE. Body weight reduction may also play a potential role.</span></span></span></p>
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