Pedro Gomes Batista, Railla Raquel Albino dos Santos Silva, Marcela Vasconcelos Montenegro, Mushrin Malik, Mrunalini Dandamudi, Juan Peres de Oliveira, Maria Eduarda Molinari, Larissa Araujo de Lucena, Ramon Huntermann, Juliana Giorgi, Caroline O. Fischer Bacca
{"title":"GLP-1受体激动剂和心肌梗死人群中2型糖尿病患者的心血管结局：系统回顾和荟萃分析","authors":"Pedro Gomes Batista, Railla Raquel Albino dos Santos Silva, Marcela Vasconcelos Montenegro, Mushrin Malik, Mrunalini Dandamudi, Juan Peres de Oliveira, Maria Eduarda Molinari, Larissa Araujo de Lucena, Ramon Huntermann, Juliana Giorgi, Caroline O. Fischer Bacca","doi":"10.1007/s40256-026-00809-5","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>Patients with type 2 diabetes mellitus (T2DM) who survive myocardial infarction (MI) remain at high risk for recurrent cardiovascular events and heart failure (HF). Although glucagon-like peptide-1 receptor agonist (GLP-1 RA) reduces cardiovascular events in stable atherosclerotic disease, its impact among patients with established MI has not been comprehensively synthesized.</p><h3>Objectives</h3><p>To evaluate the association between GLP-1 RA use and cardiovascular outcomes in patients with T2DM across MI-defined cohorts.</p><h3>Methods</h3><p>We searched MEDLINE, Embase, and Cochrane Central Register of Controlled Trials. Hazard ratios (HRs) with 95% confidence intervals (CIs) were pooled using random-effects models. Heterogeneity was evaluated using the I<sup>2</sup> statistic, and 95% prediction intervals (PIs) were calculated to estimate the expected range of true effects in future clinical settings. Outcomes included all-cause mortality, cardiovascular death, study-defined major adverse cardiovascular events (MACE), MI, stroke, and HF or hospitalization for HF. A sensitivity analysis using the Hartung–Knapp–Sidik–Jonkman (HKSJ) adjustment was performed to account for the small number of included studies and substantial heterogeneity. Statistical analysis was performed using R software version 4.5.0.</p><h3>Results</h3><p>Seven studies, including 37,393 patients with T2DM from MI-defined populations (9556 receiving GLP-1 RA), were analyzed. GLP-1 RA use was associated with lower all-cause mortality (HR, 0.67; 95% CI, 0.49–0.90; <i>I</i><sup>2</sup> = 87.3%; PI, 0.27–1.63; <i>P</i> = 0.0085), reduced study-defined MACE (HR, 0.69; 95% CI, 0.56–0.84; <i>I</i><sup>2</sup> = 55.6%; PI, 0.44–1.06; <i>P</i> = 0.0002), and fewer HF events or hospitalizations for HF (HR, 0.78; 95% CI, 0.62–0.98; <i>I</i><sup>2</sup> = 77.6%; PI, 0.42–1.45; <i>P</i> = 0.0306). No significant associations were observed for cardiovascular death (HR, 0.85; 95% CI, 0.67–1.06; <i>I</i><sup>2</sup> = 0%; PI, 0.42–1.69; <i>P</i> = 0.15), recurrent MI (HR, 0.82; 95% CI, 0.62–1.09; <i>I</i><sup>2</sup> = 63%; PI, 0.41–1.63; <i>P</i> = 0.1753), or stroke (HR, 0.91; 95% CI, 0.68–1.22; <i>I</i><sup>2</sup> = 61.2%; PI, 0.40–2.05; <i>P</i> = 0.5237). In the sensitivity analysis using the HKSJ adjustment, statistical significance was lost for all endpoints, including all-cause mortality (<i>P</i> = 0.05), study-defined MACE (<i>P</i> = 0.13), and HF or hospitalization for HF (<i>P</i> = 0.06).</p><h3>Conclusions</h3><p>In patients with T2DM across MI-defined populations, GLP-1 RA use showed signals toward lower all-cause mortality, study-defined MACE, and HF-related events; however, these findings remain exploratory because of substantial heterogeneity, wide PIs, and attenuation of statistical significance under HKSJ adjustment.</p><h3>Registration</h3><p>PROSPERO identifier no. CRD420251270326.</p><h3>Graphical Abstract</h3><div><figure><div><div><picture><source><img></source></picture></div></div></figure></div></div>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":"26 5","pages":"573 - 587"},"PeriodicalIF":3.2000,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"GLP-1 Receptor Agonists and Cardiovascular Outcomes in Patients with Type 2 Diabetes Across Myocardial Infarction-Defined Populations: A Systematic Review and Meta-Analysis\",\"authors\":\"Pedro Gomes Batista, Railla Raquel Albino dos Santos Silva, Marcela Vasconcelos Montenegro, Mushrin Malik, Mrunalini Dandamudi, Juan Peres de Oliveira, Maria Eduarda Molinari, Larissa Araujo de Lucena, Ramon Huntermann, Juliana Giorgi, Caroline O. Fischer Bacca\",\"doi\":\"10.1007/s40256-026-00809-5\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>Patients with type 2 diabetes mellitus (T2DM) who survive myocardial infarction (MI) remain at high risk for recurrent cardiovascular events and heart failure (HF). Although glucagon-like peptide-1 receptor agonist (GLP-1 RA) reduces cardiovascular events in stable atherosclerotic disease, its impact among patients with established MI has not been comprehensively synthesized.</p><h3>Objectives</h3><p>To evaluate the association between GLP-1 RA use and cardiovascular outcomes in patients with T2DM across MI-defined cohorts.</p><h3>Methods</h3><p>We searched MEDLINE, Embase, and Cochrane Central Register of Controlled Trials. Hazard ratios (HRs) with 95% confidence intervals (CIs) were pooled using random-effects models. Heterogeneity was evaluated using the I<sup>2</sup> statistic, and 95% prediction intervals (PIs) were calculated to estimate the expected range of true effects in future clinical settings. Outcomes included all-cause mortality, cardiovascular death, study-defined major adverse cardiovascular events (MACE), MI, stroke, and HF or hospitalization for HF. A sensitivity analysis using the Hartung–Knapp–Sidik–Jonkman (HKSJ) adjustment was performed to account for the small number of included studies and substantial heterogeneity. Statistical analysis was performed using R software version 4.5.0.</p><h3>Results</h3><p>Seven studies, including 37,393 patients with T2DM from MI-defined populations (9556 receiving GLP-1 RA), were analyzed. GLP-1 RA use was associated with lower all-cause mortality (HR, 0.67; 95% CI, 0.49–0.90; <i>I</i><sup>2</sup> = 87.3%; PI, 0.27–1.63; <i>P</i> = 0.0085), reduced study-defined MACE (HR, 0.69; 95% CI, 0.56–0.84; <i>I</i><sup>2</sup> = 55.6%; PI, 0.44–1.06; <i>P</i> = 0.0002), and fewer HF events or hospitalizations for HF (HR, 0.78; 95% CI, 0.62–0.98; <i>I</i><sup>2</sup> = 77.6%; PI, 0.42–1.45; <i>P</i> = 0.0306). No significant associations were observed for cardiovascular death (HR, 0.85; 95% CI, 0.67–1.06; <i>I</i><sup>2</sup> = 0%; PI, 0.42–1.69; <i>P</i> = 0.15), recurrent MI (HR, 0.82; 95% CI, 0.62–1.09; <i>I</i><sup>2</sup> = 63%; PI, 0.41–1.63; <i>P</i> = 0.1753), or stroke (HR, 0.91; 95% CI, 0.68–1.22; <i>I</i><sup>2</sup> = 61.2%; PI, 0.40–2.05; <i>P</i> = 0.5237). In the sensitivity analysis using the HKSJ adjustment, statistical significance was lost for all endpoints, including all-cause mortality (<i>P</i> = 0.05), study-defined MACE (<i>P</i> = 0.13), and HF or hospitalization for HF (<i>P</i> = 0.06).</p><h3>Conclusions</h3><p>In patients with T2DM across MI-defined populations, GLP-1 RA use showed signals toward lower all-cause mortality, study-defined MACE, and HF-related events; however, these findings remain exploratory because of substantial heterogeneity, wide PIs, and attenuation of statistical significance under HKSJ adjustment.</p><h3>Registration</h3><p>PROSPERO identifier no. CRD420251270326.</p><h3>Graphical Abstract</h3><div><figure><div><div><picture><source><img></source></picture></div></div></figure></div></div>\",\"PeriodicalId\":7652,\"journal\":{\"name\":\"American Journal of Cardiovascular Drugs\",\"volume\":\"26 5\",\"pages\":\"573 - 587\"},\"PeriodicalIF\":3.2000,\"publicationDate\":\"2026-07-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"American Journal of Cardiovascular Drugs\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://link.springer.com/article/10.1007/s40256-026-00809-5\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"American Journal of Cardiovascular Drugs","FirstCategoryId":"3","ListUrlMain":"https://link.springer.com/article/10.1007/s40256-026-00809-5","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
GLP-1 Receptor Agonists and Cardiovascular Outcomes in Patients with Type 2 Diabetes Across Myocardial Infarction-Defined Populations: A Systematic Review and Meta-Analysis
Background
Patients with type 2 diabetes mellitus (T2DM) who survive myocardial infarction (MI) remain at high risk for recurrent cardiovascular events and heart failure (HF). Although glucagon-like peptide-1 receptor agonist (GLP-1 RA) reduces cardiovascular events in stable atherosclerotic disease, its impact among patients with established MI has not been comprehensively synthesized.
Objectives
To evaluate the association between GLP-1 RA use and cardiovascular outcomes in patients with T2DM across MI-defined cohorts.
Methods
We searched MEDLINE, Embase, and Cochrane Central Register of Controlled Trials. Hazard ratios (HRs) with 95% confidence intervals (CIs) were pooled using random-effects models. Heterogeneity was evaluated using the I2 statistic, and 95% prediction intervals (PIs) were calculated to estimate the expected range of true effects in future clinical settings. Outcomes included all-cause mortality, cardiovascular death, study-defined major adverse cardiovascular events (MACE), MI, stroke, and HF or hospitalization for HF. A sensitivity analysis using the Hartung–Knapp–Sidik–Jonkman (HKSJ) adjustment was performed to account for the small number of included studies and substantial heterogeneity. Statistical analysis was performed using R software version 4.5.0.
Results
Seven studies, including 37,393 patients with T2DM from MI-defined populations (9556 receiving GLP-1 RA), were analyzed. GLP-1 RA use was associated with lower all-cause mortality (HR, 0.67; 95% CI, 0.49–0.90; I2 = 87.3%; PI, 0.27–1.63; P = 0.0085), reduced study-defined MACE (HR, 0.69; 95% CI, 0.56–0.84; I2 = 55.6%; PI, 0.44–1.06; P = 0.0002), and fewer HF events or hospitalizations for HF (HR, 0.78; 95% CI, 0.62–0.98; I2 = 77.6%; PI, 0.42–1.45; P = 0.0306). No significant associations were observed for cardiovascular death (HR, 0.85; 95% CI, 0.67–1.06; I2 = 0%; PI, 0.42–1.69; P = 0.15), recurrent MI (HR, 0.82; 95% CI, 0.62–1.09; I2 = 63%; PI, 0.41–1.63; P = 0.1753), or stroke (HR, 0.91; 95% CI, 0.68–1.22; I2 = 61.2%; PI, 0.40–2.05; P = 0.5237). In the sensitivity analysis using the HKSJ adjustment, statistical significance was lost for all endpoints, including all-cause mortality (P = 0.05), study-defined MACE (P = 0.13), and HF or hospitalization for HF (P = 0.06).
Conclusions
In patients with T2DM across MI-defined populations, GLP-1 RA use showed signals toward lower all-cause mortality, study-defined MACE, and HF-related events; however, these findings remain exploratory because of substantial heterogeneity, wide PIs, and attenuation of statistical significance under HKSJ adjustment.
期刊介绍：
Promoting rational therapy within the discipline of cardiology, the American Journal of Cardiovascular Drugs covers all aspects of the treatment of cardiovascular disorders, particularly the place in therapy of newer and established agents.
Via a program of reviews and original clinical research articles, the journal addresses major issues relating to treatment of these disorders, including the pharmacology, efficacy and adverse effects of the major classes of drugs; information on newly developed drugs and drug classes; the therapeutic implications of latest research into the aetiology of cardiovascular disorders; and the practical management of specific clinical situations.
The American Journal of Cardiovascular Drugs offers a range of additional enhanced features designed to increase the visibility, readership and educational value of the journal’s content. Each article is accompanied by a Key Points summary, giving a time-efficient overview of the content to a wide readership. Articles may be accompanied by plain language summaries to assist patients, caregivers and others in understanding important medical advances. The journal also provides the option to include various other types of enhanced features including slide sets, videos and animations. All enhanced features are peer reviewed to the same high standard as the article itself. Peer review is conducted using Editorial Manager®, supported by a database of international experts. This database is shared with other Adis journals.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
