Thomaz Alexandre Costa, Nicole Felix, Gabriel Cavalcante Lima Chagas, Santiago Teran, Madelyn Boslough, Vrushali Shelar, Matthew M Y Lee, Ambarish Pandey, Marconi Abreu, Darren K McGuire, Josephine Harrington
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引用次数: 0
摘要
目的：肥胖是心力衰竭的主要危险因素，并伴有轻微的射血分数降低或保留。这项随机临床试验（RCTs）的荟萃分析评估了基于肠促胰岛素的治疗（IBTs），包括胰高血糖素样肽-1受体激动剂（GLP-1 RAs）和双重GIP/GLP-1 RAs，对肥胖- hfpef表型个体临床结果的影响。材料和方法：通过2024年12月对PubMed、EMBASE和Web of Science的系统搜索，确定了在HFpEF和肥胖患者中比较IBTs和安慰剂的随机对照试验。采用反方差随机效应模型对二元结果进行风险比（hr）或95%置信区间（CIs）的优势比（ORs）合并，对连续结果进行估计差异（EDs）合并。结果和结论：纳入6项随机对照试验，7282名受试者（50.3%接受IBTs）。IBTs降低了心血管死亡或心衰恶化的风险(HR 0.74；95% ci 0.63-0.88；I2 = 0%)，心衰事件加重(HR 0.62；95% ci 0.47-0.81；I2 = 16%)和全因死亡率(OR 0.81；95% ci 0.67-0.99；I2 = 0%)。单在心血管疾病死亡率方面没有发现显著差异。IBTs还改善了肥胖- hfpef患者的生活质量、功能状态、收缩压和体重减轻。
Incretin-based therapies for individuals with obesity and heart failure with mildly reduced or preserved ejection fraction: A systematic review and meta-analysis of randomized controlled trials.
Aims: Obesity is a major risk factor for heart failure with mildly reduced or preserved ejection fraction (HFpEF). This meta-analysis of randomised clinical trials (RCTs) evaluated the effects of incretin-based therapies (IBTs), including glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and dual GIP/GLP-1 RAs, on clinical outcomes in individuals with the obesity-HFpEF phenotype.
Materials and methods: A systematic search of PubMed, EMBASE and Web of Science through December 2024 identified RCTs comparing IBTs with placebo in patients with HFpEF and obesity. Hazard ratios (HRs) or odds ratios (ORs) with 95% confidence intervals (CIs) were pooled for binary outcomes, and estimated differences (EDs) for continuous outcomes, using an inverse variance random-effects model.
Results and conclusions: Six RCTs with 7282 participants (50.3% receiving IBTs) were included. IBTs reduced the risk of cardiovascular death or worsening HF (HR 0.74; 95% CI 0.63-0.88; I2 = 0%), worsening HF events (HR 0.62; 95% CI 0.47-0.81; I2 = 16%) and all-cause mortality (OR 0.81; 95% CI 0.67-0.99; I2 = 0%) compared to placebo. No significant difference was found in cardiovascular mortality alone. IBTs also improved quality of life, functional status, systolic blood pressure and weight loss in patients with obesity-HFpEF.
期刊介绍：
Diabetes, Obesity and Metabolism is primarily a journal of clinical and experimental pharmacology and therapeutics covering the interrelated areas of diabetes, obesity and metabolism. The journal prioritises high-quality original research that reports on the effects of new or existing therapies, including dietary, exercise and lifestyle (non-pharmacological) interventions, in any aspect of metabolic and endocrine disease, either in humans or animal and cellular systems. ‘Metabolism’ may relate to lipids, bone and drug metabolism, or broader aspects of endocrine dysfunction. Preclinical pharmacology, pharmacokinetic studies, meta-analyses and those addressing drug safety and tolerability are also highly suitable for publication in this journal. Original research may be published as a main paper or as a research letter.
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