胰高血糖素样肽-1受体激动剂和钠-葡萄糖共转运蛋白-2抑制剂在动脉粥样硬化性心血管疾病表型中的心血管疗效比较：系统回顾和荟萃分析

IF 6.1 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

European Heart Journal - Cardiovascular Pharmacotherapy Pub Date : 2025-03-13 DOI:10.1093/ehjcvp/pvae093

Yu-Min Lin, Jheng-Yan Wu, Mei-Chuan Lee, Chen-Lun Su, Han Siong Toh, Wei-Ting Chang, Sih-Yao Chen, Fang-Hsiu Kuo, Hsin-Ju Tang, Chia-Te Liao

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引用次数: 0

摘要

背景：动脉粥样硬化性心血管疾病（ASCVD）包括多种表型，主要不良心血管事件（mace）的风险升高。本研究旨在评估胰高血糖素样肽-1受体激动剂（GLP-1 RAs）和钠-葡萄糖共转运蛋白-2抑制剂（SGLT2is）在不同ASCVD表型中的心血管疗效。方法和结果：我们对评估GLP-1 RAs或SGLT2is对ASCVD患者安慰剂或标准治疗效果的随机对照试验进行了系统回顾和荟萃分析。主要结局包括MACE，定义为心血管死亡率、非致死性心肌梗死和非致死性卒中。采用随机效应模型计算95%置信区间的风险比（rr）。纳入26项试验（15789例患者）。GLP-1 RAs和SGLT2is均可显著降低ASCVD患者的MACE发生率(RR 0.85；两者的95% CI为0.80-0.91)。GLP-1 RAs对外周动脉疾病有显著疗效(RR 0.86；95% CI 0.76-0.98)和急性后心血管事件(RR 0.90；95% ci 0.83-0.97)。在伴有心力衰竭的ASCVD患者中，两种药物均可降低MACE (GLP-1 RAs: RR 0.73；95% ci 0.63-0.84；SGLT2is: RR 0.86；95% ci 0.78-0.95)。sglt2s显著降低ASCVD合并慢性肾脏疾病的MACE (RR 0.84；95% CI 0.72-0.99)，尤其是严重蛋白尿(RR 0.61；95% ci 0.37-0.99)。结论：GLP-1 RAs和SGLT2is在ASCVD表型中表现出不同的心血管有效性。GLP-1 RAs在外周动脉疾病和急性后心血管事件中表现出特别的益处，而SGLT2is在ASCVD合并慢性肾脏疾病中表现出独特的优势。这两种药物对心力衰竭都有效。这些发现支持基于特定合并症和危险因素为不同ASCVD参与者量身定制治疗策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

Comparative cardiovascular effectiveness of glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter-2 inhibitors in atherosclerotic cardiovascular disease phenotypes: a systematic review and meta-analysis.

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Background: Atherosclerotic cardiovascular disease (ASCVD) encompasses various phenotypes with elevated risks of major adverse cardiovascular events (MACEs). This study aimed to assess the comparative cardiovascular effectiveness of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT2is) across diverse ASCVD phenotypes.

Methods and results: We conducted a systematic review and meta-analysis of randomized controlled trials evaluating GLP-1 RAs or SGLT2is against placebo or standard care in ASCVD patients. Primary outcomes included MACE, defined as cardiovascular mortality, non-fatal myocardial infarction, and non-fatal stroke. Risk ratios (RRs) with 95% confidence interval (CI) were calculated using a random-effects model.Twenty-six trials (151 789 patients) were included. Both GLP-1 RAs and SGLT2is significantly reduced MACE rates in ASCVD patients (RR 0.85; 95% CI 0.80-0.91 for both). GLP-1 RAs showed significant effectiveness in peripheral artery disease (RR 0.86; 95% CI 0.76-0.98) and post-acute cardiovascular events (RR 0.90; 95% CI 0.83-0.97). In ASCVD with heart failure, both drug classes reduced MACE (GLP-1 RAs: RR 0.73; 95% CI 0.63-0.84; SGLT2is: RR 0.86; 95% CI 0.78-0.95). SGLT2is significantly reduced MACE in ASCVD with chronic kidney disease (RR 0.84; 95% CI 0.72-0.99), particularly in severe albuminuria (RR 0.61; 95% CI 0.37-0.99).

Conclusion: GLP-1 RAs and SGLT2is exhibit distinct cardiovascular effectiveness profiles across ASCVD phenotypes. GLP-1 RAs show particular benefits in peripheral artery disease and post-acute cardiovascular events, while SGLT2is demonstrate unique advantages in ASCVD with comorbid chronic kidney disease. Both are effective in heart failure. These findings support tailored treatment strategies for diverse ASCVD participants based on specific comorbidities and risk factors.

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来源期刊

European Heart Journal - Cardiovascular Pharmacotherapy Medicine-Cardiology and Cardiovascular Medicine

CiteScore

10.10

自引率

14.10%

发文量

期刊介绍： The European Heart Journal - Cardiovascular Pharmacotherapy (EHJ-CVP) is an international, peer-reviewed journal published in English, specifically dedicated to clinical cardiovascular pharmacology. EHJ-CVP publishes original articles focusing on clinical research involving both new and established drugs and methods, along with meta-analyses and topical reviews. The journal's primary aim is to enhance the pharmacological treatment of patients with cardiovascular disease by interpreting and integrating new scientific developments in this field. While the emphasis is on clinical topics, EHJ-CVP also considers basic research articles from fields such as physiology and molecular biology that contribute to the understanding of cardiovascular drug therapy. These may include articles related to new drug development and evaluation, the physiological and pharmacological basis of drug action, metabolism, drug interactions, and side effects.