Comparative efficacy of glucagon-like peptide-1 receptor agonists for cardiovascular outcomes in Asian versus White persons: systematic review and meta-analyses of randomized trials with and without type 2 diabetes and/or overweight/obesity

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posted on 2025-02-20, 16:26 authored by Matthew M. Y. Lee, Nazim Ghouri, Anoop Misra, Yu Mi Kang, Martin K. Rutter, Hertzel C. Gerstein, Darren K. McGuire, Naveed Sattar

BACKGROUND

Cardiovascular outcome trials (CVOTs) suggest glucagon-like peptide-1 receptor agonists (GLP-1RAs) may provide greater cardiovascular (CV) benefits in Asians compared to Whites.

PURPOSE

Compare CV efficacy of GLP-1RAs in Asians versus Whites.

DATA SOURCES

Systematic review of PubMed and ClinicalTrials.gov (January 1, 2015-November 1, 2024). PROSPERO: CRD42024493010.

STUDY SELECTION

Randomized placebo-controlled CVOTs of GLP-1RAs. Risk of bias was assessed (RoB 2).

DATA EXTRACTION

Ethnicity-specific hazard ratios (HRs) for major adverse cardiovascular events (MACE).

DATA SYNTHESIS

Random-effects meta-analyses per PRISMA guidelines included eight trials (5,909 Asians, 55,855 Whites). GLP-1RA-associated MACE HR was 0.69 (95% CI: 0.58, 0.83) in Asians and 0.85 (95% CI: 0.79, 0.91) in Whites (p_interaction=0.045). Absolute MACE risk reduction was 2.9% (95% CI: 1.5, 4.2) in Asians versus 1.4% (0.9, 1.9) in Whites.

LIMITATIONS

Lack of individual patient-level data precluded detailed sub-classification of the Asian group.

CONCLUSIONS

GLP-1RAs may offer greater MACE reductions in Asians compared to Whites.