Effects of first-line antidiabetic drugs on the improvement of arterial stiffness: A Bayesian network meta-analysis 一线降糖药物对动脉硬化改善的影响:贝叶斯网络荟萃分析

IF 3 2区医学 Q2 ENDOCRINOLOGY & METABOLISM

Journal of Diabetes Pub Date : 2023-05-10 DOI:10.1111/1753-0407.13405

Jincheng Wang, Yuhan Wang, Yueheng Wang, Yu Li, Jiamei Zhang, Han Zhang, Xiaomin Fu, Zhiqin Guo, Ying Yang, Kaining Kang, Wei Zhang, Li Tian, Yanqiang Wu, Shuanli Xin, Hongzhou Liu

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引用次数: 1

Abstract

Background

Changes in vascular function are closely associated with the development of cardiovascular disease (CVD). Pulse wave velocity (PWV) is a potential indicator of vascular dysfunction; it allows noninvasive assessment of arterial stiffness. Currently, evidence for the effects of different classes of antidiabetic drugs on arterial stiffness remains limited. In this study, a network meta-analysis (NMA) was performed to explore the associations between changes in arterial stiffness and first-line antidiabetic drugs by evaluating PWV in patients with different metabolic abnormalities.

Methods

We systematically searched several electronic databases for randomized controlled trials (RCTs) published from inception until 25 August 2022, without language restrictions. The primary outcome was the change in PWV (ΔPWV) in all included studies; subgroup analysis was performed for patients with abnormal glucose metabolism, including prediabetes and diabetes mellitus. NMA was performed to calculate the mean differences (MDs) with 95% confidence intervals (CIs) as effect sizes to evaluate the ΔPWV.

Results

Among the 2257 candidate articles identified in the initial search, 18 RCTs were eventually included in the analysis. In all studies, two classes of new antidiabetic drugs, glucagon-like peptide-1 receptor (GLP-1R) agonists and sSodium-glucose co-transporter 2 (SGLT-2) inhibitors, improved arterial stiffness by decreasing PWV compared with placebo (MD = −1.11, 95% CI: −1.94 to 0.28) and (MD = −0.76, 95% CI: −1.45 to −0.08). A conventional antidiabetic drug, metformin, also showed similar efficacy compared with placebo (MD = −0.73, 95% CI: −1.33 to −0.12). Finally, in subgroup studies of patients with abnormal glucose metabolism diseases, GLP-1R agonists (MD = −1.06, 95% CI: −2.05 to −0.10) significantly decreased PWV compared with placebo.

Conclusion

Three classes of antidiabetic drugs—GLP-1R agonists, SGLT-2 inhibitors, and metformin—have the potential to improve arterial stiffness. Among the six classes of antidiabetic drugs analyzed, GLP-1R agonists constitute the only class of drugs that improves arterial stiffness in patients with abnormal glucose metabolism diseases.

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Effects of first-line antidiabetic drugs on the improvement of arterial stiffness: A Bayesian network meta-analysis 一线降糖药物对动脉硬化改善的影响:贝叶斯网络荟萃分析

背景血管功能的改变与心血管疾病(CVD)的发生密切相关。脉搏波速度(PWV)是血管功能障碍的潜在指标;它允许对动脉硬度进行无创评估。目前，关于不同类型的抗糖尿病药物对动脉僵硬的影响的证据仍然有限。本研究通过网络meta分析(network meta-analysis, NMA)对不同代谢异常患者的PWV进行评估，探讨动脉僵硬度变化与一线降糖药的关系。方法我们系统地检索了几个电子数据库，检索了从开始到2022年8月25日发表的随机对照试验(rct)，没有语言限制。在所有纳入的研究中，主要结局是PWV的变化(ΔPWV);对糖代谢异常患者进行亚组分析，包括糖尿病前期和糖尿病。采用NMA计算平均差异(MDs)， 95%置信区间(ci)作为效应量，评估ΔPWV。在最初检索到的2257篇候选文章中，18篇rct最终被纳入分析。在所有研究中，两类新的降糖药，胰高血糖素样肽-1受体(GLP-1R)激动剂和s钠-葡萄糖共转运蛋白2 (SGLT-2)抑制剂，与安慰剂相比，通过降低PWV改善动脉硬度(MD = - 1.11, 95% CI: - 1.94至0.28)和(MD = - 0.76, 95% CI: - 1.45至- 0.08)。传统降糖药二甲双胍也显示出与安慰剂相似的疗效(MD = - 0.73, 95% CI: - 1.33至- 0.12)。最后，在糖代谢异常疾病患者的亚组研究中，与安慰剂相比，GLP-1R激动剂(MD = - 1.06, 95% CI: - 2.05至- 0.10)显著降低PWV。结论3类降糖药物glp - 1r激动剂、SGLT-2抑制剂和二甲双胍具有改善动脉僵硬的潜力。在分析的六类降糖药物中，GLP-1R激动剂是唯一一类改善糖代谢异常疾病患者动脉僵硬度的药物。

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来源期刊

Journal of Diabetes ENDOCRINOLOGY & METABOLISM-

CiteScore

6.50

自引率

2.20%

发文量

审稿时长

>12 weeks

期刊介绍： Journal of Diabetes (JDB) devotes itself to diabetes research, therapeutics, and education. It aims to involve researchers and practitioners in a dialogue between East and West via all aspects of epidemiology, etiology, pathogenesis, management, complications and prevention of diabetes, including the molecular, biochemical, and physiological aspects of diabetes. The Editorial team is international with a unique mix of Asian and Western participation. The Editors welcome submissions in form of original research articles, images, novel case reports and correspondence, and will solicit reviews, point-counterpoint, commentaries, editorials, news highlights, and educational content.