Meta-analyses of Results From Randomized Outcome Trials Comparing Cardiovascular Effects of SGLT2is and GLP-1RAs in Asian Versus White Patients With and Without Type 2 Diabetes
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posted on 2021-03-11, 08:43 authored by Matthew M. Y. Lee, Nazim Ghouri, Darren K. McGuire, Martin K. Rutter, Naveed SattarBACKGROUND:
<p>Results of cardiovascular
outcome trials (CVOTs) suggest Asians may derive greater benefit than Whites with
newer classes of antihyperglycemic medications. </p>
<p> </p>
<p>PURPOSE: </p>
<p>To provide summary
hazard ratio (HR) estimates for cardiovascular efficacy of sodium-glucose
co-transporter 2 inhibitors (SGLT2i) and glucagon-like peptide receptor
agonists (GLP-1RA) stratified by race (Asian vs. White). </p>
<p> </p>
<p>DATA SOURCES:</p>
<p>A systematic review
performed in PubMed from January 01, 2015 to December 08, 2020. </p>
<p> </p>
<p>STUDY SELECTION:</p>
<p>Randomized placebo-controlled
CVOTs of SGLT2is and GLP-1RAs that reported HR (95% CI) for (i) MACE, and (ii)
cardiovascular (CV) death/ and hospitalization for heart failure (HHF). </p>
<p> </p>
<p>DATA EXTRACTION AND
SYNTHESIS: </p>
<p>The HR (95% CI) for
selected outcomes in Asians and Whites was extracted from each trial, adhering
to PRISMA guidelines. Random-effects meta-analyses were performed to examine
differences between the selected outcomes in Asians vs. Whites. </p>
<p> </p>
<p>RESULTS:</p>
<p>In 5 SGLT2i trials,
the MACE outcome HR (95% CI) in 3,980 Asians vs. 29,007 Whites was 0.81 (0.60, 1.01)
vs. 0.86 (0.76, 0.97), respectively (p<sub>interaction</sub>=0.64). In 2 SGLT2i
trials, the CV death/HHF outcome in 1,788 Asians vs. 5,962 Whites was 0.60
(0.47, 0.74) vs. 0.82 (0.73, 0.92), respectively (p<sub>interaction</sub>=0.01).
In 6 GLP-1RA trials, the MACE outcome in 4,195 Asians vs. 37,530 Whites was 0.68
(0.53, 0.84) vs. 0.87 (0.81, 0.94), respectively (p<sub>interaction</sub>=0.03).
</p>
<p> </p>
<p>LIMITATIONS:</p>
<p>Lack of individual
patient-level data, relatively short duration of trial observation, and lack of
granular categorization of race with the broadly-defined Asian subgroups. </p>
<p> </p>
<p>CONCLUSIONS:</p>
<p>Compared with
Whites, Asians may derive greater HHF/CV death benefit from SGLT2is and MACE
benefit from GLP-1RA. </p>
