A systematic review and meta-analysis comparing the cardiovascular effects of sodium-glucose co-transporter-2 inhibitors and glucagon-like peptide-1 agonists in type 2 diabetes.

IF 2.1 Q4 ENDOCRINOLOGY & METABOLISM

Journal of Diabetes and Metabolic Disorders Pub Date : 2025-10-11 eCollection Date: 2025-12-01 DOI:10.1007/s40200-025-01741-2

Laibah Arshad Khan, Khudija Sadia, Rahma Naveed, Rehan Khalid, Rabail Faisal, Abdur Rafay Bilal, Ayeza Nawaz, Abdullah Safdar, Talha Saleh Bin Siddique, Saleh Saeed Ahmad, Muhammad Ubaid Hussain, Muhammad Talha Asghar, Wajdan Ahmad

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引用次数: 0

Abstract

Purpose: Sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 agonists have been shown to improve cardiovascular health. This meta-analysis aims to directly compare their cardiovascular outcomes in type 2 diabetes patients (T2DM).

Methodology: We searched Medline, Scopus, Cochrane, and Web of Science from inception to August 2025 for observational studies that compared SGLT2 inhibitors and GLP-1 agonists in type 2 diabetes patients and baseline cardiovascular diseases (CVD). The primary outcomes were Major Adverse Cardiovascular Events (MACE) and heart failure (HF), while the secondary outcomes included all-cause mortality, cardiovascular mortality, myocardial infarction (MI), and stroke. The pooled hazard ratio with 95% confidence interval (CI) was employed through a random-effects model, and a p-value < 0.05 was considered statistically significant.

Results: Nineteen studies comprising 1,893,359 patients (1,182,641; SGLT2 inhibitors,710,718; GLP-1 agonists). Compared to GLP-1 agonist, SGLT2 inhibitor use was associated with a significant 18% reduced risk of heart failure in T2DM patients, while a non significantly reduced risk of MACE, all-cause mortality, cardiovascular mortality, myocardial infarction, and stroke. In T2DM patients with pre-existing CVD, SGLT2 inhibitors showed a significant 14% reduced risk of heart failure, 10% reduced risk of myocardial infarction, and 7% borderline reduced risk of all-cause mortality compared to GLP-1 agonists. In T2DM patients without pre-existing CVD, SGLT2 inhibitors demonstrated a significant 17% reduced risk of heart failure, with a non-significant reduction in MACE, all-cause mortality, and myocardial infarction compared to GLP-1 agonists, and a non-significantly increased risk of cardiovascular mortality and stroke.

Conclusion: Use of SGLT2 inhibitors was associated with a lower risk of HF in T2DM, along with a lower risk of HF, MI, and all-cause mortality with pre-existing CVD compared to GLP-1 agonists. However, high heterogeneity and a lack of RCTs warrant cautious clinical implications.

Supplementary information: The online version contains supplementary material available at 10.1007/s40200-025-01741-2.

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一项比较钠-葡萄糖共转运蛋白-2抑制剂和胰高血糖素样肽-1激动剂对2型糖尿病心血管影响的系统综述和荟萃分析。

目的：钠-葡萄糖共转运蛋白-2抑制剂和胰高血糖素样肽-1激动剂已被证明可改善心血管健康。本荟萃分析旨在直接比较2型糖尿病患者（T2DM）的心血管结局。方法：我们检索了Medline、Scopus、Cochrane和Web of Science从成立到2025年8月的观察性研究，比较了SGLT2抑制剂和GLP-1激动剂在2型糖尿病患者和基线心血管疾病（CVD）中的作用。主要结局是主要不良心血管事件（MACE）和心力衰竭（HF），次要结局包括全因死亡率、心血管死亡率、心肌梗死（MI）和卒中。通过随机效应模型采用95%置信区间（CI）的合并风险比和p值结果：19项研究包括1,893,359例患者（1,182,641例；SGLT2抑制剂，710,718例；GLP-1激动剂）。与GLP-1激动剂相比，使用SGLT2抑制剂与T2DM患者心力衰竭风险显著降低18%相关，而MACE、全因死亡率、心血管死亡率、心肌梗死和卒中风险无显著降低。在伴有心血管疾病的T2DM患者中，与GLP-1激动剂相比，SGLT2抑制剂可显著降低14%的心力衰竭风险、10%的心肌梗死风险和7%的全因死亡率风险。在无CVD的T2DM患者中，与GLP-1激动剂相比，SGLT2抑制剂可显著降低17%的心力衰竭风险，MACE、全因死亡率和心肌梗死的风险无显著降低，心血管死亡率和卒中的风险无显著增加。结论：与GLP-1激动剂相比，使用SGLT2抑制剂可降低T2DM患者HF的风险，同时降低HF、MI和全因死亡率。然而，高异质性和缺乏随机对照试验需要谨慎的临床意义。补充资料：在线版本提供补充资料，网址为10.1007/s40200-025-01741-2。

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来源期刊

Journal of Diabetes and Metabolic Disorders Medicine-Internal Medicine

CiteScore

4.80

自引率

3.60%

发文量

210

期刊介绍： Journal of Diabetes & Metabolic Disorders is a peer reviewed journal which publishes original clinical and translational articles and reviews in the field of endocrinology and provides a forum of debate of the highest quality on these issues. Topics of interest include, but are not limited to, diabetes, lipid disorders, metabolic disorders, osteoporosis, interdisciplinary practices in endocrinology, cardiovascular and metabolic risk, aging research, obesity, traditional medicine, pychosomatic research, behavioral medicine, ethics and evidence-based practices.As of Jan 2018 the journal is published by Springer as a hybrid journal with no article processing charges. All articles published before 2018 are available free of charge on springerlink.Unofficial 2017 2-year Impact Factor: 1.816.