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Curr Diabetes Rev. 2017 Apr 14. doi: 10.2174/1573399813666170414101450. [Epub ahead of print]

Effect of glucagon-like peptide-1 receptor agonists on all-cause mortality and cardiovascular outcomes: A meta-analysis.

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1
University of British Columbia - Faculty of Pharmaceutical Sciences Vancouver. Canada.

Abstract

BACKGROUND:

Cardiovascular disease is the leading cause of death in patients with type 2 diabetes.

OBJECTIVE:

To assess the impact of glucagon-like peptide-1 receptor agonist (GLP1RA) therapy, compared to placebo, on clinically relevant outcomes including all-cause mortality, cardiovascular mortality, nonfatal myocardial infarction (MI), nonfatal stroke, and hospitalizations for heart failure, in patients with type 2 diabetes.

METHOD:

EMBASE, MEDLINE, and CENTRAL were searched (inception to September 2016) for randomized, double-blind, placebo-controlled trials of at least one year in duration that compared any GLP1RA to placebo in patients with type 2 diabetes. Both authors independently completed the literature search, data extraction, and risk of bias assessment. For each outcome, a risk ratio (RR) and 95% confidence interval (CI) were calculated using a Mantel-Haenszel random effects model.

RESULTS:

Eight trials (three albiglutide, two lixisenatide, two liraglutide, one semaglutide) consisting of 21,135 patients were included. Most patients had, or were at high risk for, cardiovascular disease. Follow-up ranged from 1-3.8 years. Trials contributing the majority of data were deemed to have a low risk of bias. The risk of all-cause mortality was lowered by 11% in patients receiving a GLP1RA (RR 0.89, 95% CI 0.81-0.99). There was no statistically significant difference between groups with respect to cardiovascular death, nonfatal MI, nonfatal stroke, or hospitalizations for heart failure.

CONCLUSION:

GLP1RA therapy when compared to placebo reduced all-cause mortality in high cardiovascular risk patients with type 2 diabetes. They did not impact cardiovascular mortality, nonfatal MI, nonfatal stroke, or heart failure hospitalizations.

KEYWORDS:

Glucagon-like peptide-1 receptor agonists; cardiovascular diseases; hypoglycemic agents; incretins; liraglutide; type 2 diabetes mellitus

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