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
Results of cardiovascular outcome trials (CVOTs) suggest Asians may derive greater benefit than Whites with newer classes of antihyperglycemic medications.
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).
A systematic review performed in PubMed from January 01, 2015 to December 08, 2020.
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.
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).
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.
Compared with Whites, Asians may derive greater HHF/CV death benefit from SGLT2is and MACE benefit from GLP-1RA.