Cardiovascular and Renal Benefits of Novel Diabetes Drugs by Baseline Cardiovascular Risk: A Systematic Review, Meta-analysis, and Meta-regression
Authors' conclusion
Relative effects of novel diabetes drugs are preserved across baseline cardiovascular risk, whereas absolute benefits increase at higher risks, particularly regarding heart failure. Our findings suggest a need for baseline risk assessment tools to identify variation in absolute treatment benefits and improve decision-making.
Study context
- Population
- Adult patients with diabetes in confirmatory GLP-1 RA and SGLT2i RCTs; PubMed through 7 November 20229 GLP-1RA and 13 SGLT2i trials
- Participants
- 154,649 patients
- Comparison
- GLP-1 RA and SGLT2i: cardiovascular and renal benefits by baseline cardiovascular risk
- Outcome
- Summary HRs by drug class
Pooled result
As reported in the abstract
| Group | HR cardiovascular mortality | HR MACE | HR HF | HR renal outcomes | HR stroke |
|---|---|---|---|---|---|
| GLP-1RA | 0.87 | 0.87 | 0.89 | 0.84 | 0.84 |
| SGLT2i | 0.86 | 0.88 | 0.70 | 0.65 | 0.92 |
HR cardiovascular mortality
GLP-1RA0.87
SGLT2i0.86
HR MACE
GLP-1RA0.87
SGLT2i0.88
HR HF
GLP-1RA0.89
SGLT2i0.70
HR renal outcomes
GLP-1RA0.84
SGLT2i0.65
HR stroke
GLP-1RA0.84
SGLT2i0.92
Further pooled results
5-year absolute risk reductions by baseline risk
- 5-year absolute risk reductions
- 0.80-4.25%
- Increased to 11.6% for HF in SGLT2i trials in high-risk patients
- Pslope < 0.001
- For GLP-1RA, associations nonsignificant
Original publication
Cardiovascular and Renal Benefits of Novel Diabetes Drugs by Baseline Cardiovascular Risk: A Systematic Review, Meta-analysis, and Meta-regression. Diabetes Care. Published 23 May 2023. doi:10.
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