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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 11.03.2021, 08:43 by Matthew M. Y. Lee, Nazim Ghouri, Darren K. McGuire, Martin K. Rutter, Naveed Sattar
BACKGROUND:

Results of cardiovascular outcome trials (CVOTs) suggest Asians may derive greater benefit than Whites with newer classes of antihyperglycemic medications.

PURPOSE:

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).

DATA SOURCES:

A systematic review performed in PubMed from January 01, 2015 to December 08, 2020.

STUDY SELECTION:

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).

DATA EXTRACTION AND SYNTHESIS:

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.

RESULTS:

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 (pinteraction=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 (pinteraction=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 (pinteraction=0.03).

LIMITATIONS:

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.

CONCLUSIONS:

Compared with Whites, Asians may derive greater HHF/CV death benefit from SGLT2is and MACE benefit from GLP-1RA.

Funding

This work was supported by the British Heart Foundation Centre of Research Excellence Grant RE/18/6/34217 to N.S. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.

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