Kardiovaskularni ishodi povezani sa inhibitorima SGLT-2 u odnosu na druge lijekove za snižavanje glukoze kod pacijenata sa dijabetesom tipa 2: Sistematski pregled i meta-analiza u stvarnom svijetu.
PloS one
Sažetak istraživanja
Pozadina i ciljevi Sredstva za snižavanje glukoze koja smanjuju rizik od velikih štetnih kardiovaskularnih događaja (MACE) smatrala bi se velikim napretkom. Smanjenje kardiovaskularnog rizika inhibitorima kotransportera natrijum-glukoze 2 (SGLT-2i) potvrđeno je nekim velikim randomiziranim kontroliranim studijama (RCT) i sistematskim pregledima RCT-a, ali su tačni pokazatelji kardiovaskularnog rizika ostali kontroverzni. Nejasno je da li se u kliničkoj praksi mogu dobiti konzistentni rezultati. Stoga smo u ovoj meta-analizi analizirali stvarni efekat SGLT-2i na kardiovaskularni ishod kod pacijenata sa dijabetes melitusom tipa 2 (T2DM).
Metode Uradili smo sistematski pregled i meta-analizu kardiovaskularnog ishoda SGLT-2i u stvarnom svijetu kod pacijenata sa T2DM. Pretražili smo PubMed i Embase za ispitivanja objavljena do 23. oktobra 2019. Pretraga i izdvajanje podataka završeni su standardiziranim obrascem podataka, a sva odstupanja su riješena konsenzusom. Primarni ishod je bio MACE i smrtnost od svih uzroka (ACM). Sekundarni ishodi su bili hospitalizacija zbog zatajenja srca (HHF), atrijalne fibrilacije (AF), infarkta miokarda (MI), moždanog udara, kardiovaskularnog mortaliteta (CVM), nestabilne angine pektoris (UA), srčane insuficijencije (HF). Odnos šanse (OR) sa 95% CI su objedinjeni u ispitivanjima, a kardiovaskularni ishodi su stratifikovani prema početnoj incidenci kardiovaskularnih bolesti (KVB), stopi upotrebe kardiovaskularnog lijeka, periodu praćenja i regionu.
Rezultati Uključeno je četrnaest studija koje su uključivale 3.157.259 pacijenata. SGLT-2i smanjen MACE (OR, 0,71; 95% CI 0,67,0,75, P 80% ili zaključci Preovlađujući uticaj SGLT-2i je na kardiovaskularni ishod potaknut uglavnom smanjenjem MACE, ACM, HHF, MI, moždanog udara, CVF-a, ali nema robusnog HLTF-a, CVM-a. Prednosti u smanjenju MACE, ACM, HHF, MI, moždanog udara, CVM i HF, bez obzira na istoriju upotrebe GLP-1RA i/ili statina i/ili metformina, ne povećavaju rizik od teške hipoglikemije i amputacije donjih ekstremiteta.
Prikaži originalni naslov i sažetak na engleskom
Cardiovascular outcomes associated with SGLT-2 inhibitors versus other glucose-lowering drugs in patients with type 2 diabetes: A real-world systematic review and meta-analysis.
Background and aims Glucose lowering agents that reduce the risk of major adverse cardiovascular events (MACE) would be considered a major advance. The reduction of cardiovascular risk by sodium-glucose cotransporter 2 inhibitors (SGLT-2i) has been confirmed by some large-scale randomized controlled studies (RCTs) and systematic reviews of RCTs, but exact indicators of cardiovascular risk remained controversial. Whether consistent results can be obtained in clinical practice is unclear. Therefore, in this meta-analysis, we analyzed the real-world effect of SGLT-2i on cardiovascular outcome in patients with type 2 diabetes mellitus (T2DM).
Methods We did a real-world systematic review and meta-analysis of cardiovascular outcome of SGLT-2i in patients with T2DM. We searched PubMed and Embase for trials published up to October 23, 2019. Data search and extraction were completed with a standardized data form and any discrepancies were resolved by consensus. The primary outcome was MACE and all-cause mortality (ACM). Secondary outcomes were hospitalization for heart failure (HHF), atrial fibrillation (AF), myocardial infarction (MI), stroke, cardiovascular mortality (CVM), unstable angina (UA), heart failure (HF). Odds ratio (OR) with 95% CIs were pooled across trials, and cardiovascular outcomes were stratified by baseline incidence of cardiovascular disease (CVD), usage rate of cardiovascular benefit drug, follow-up period and region.
Results Fourteen trials enrolling 3,157,259 patients were included. SGLT-2i reduced MACE (OR, 0.71; 95% CI 0.67,0.75, P 80% or
Conclusions The predominant impact of SGLT-2i is on cardiovascular outcome driven predominantly by reduction in MACE, ACM, HHF, MI, stroke, CVM, HF, but not UA or AF. SGLT-2i has robust benefits on reducing MACE, ACM, HHF, MI, stroke, CVM and HF regardless of a history of usage rate of GLP-1RA and/or statins and /or metformin. SGLT-2i does not increase the risk of severe hypoglycemia and lower limb amputation.
Izvorni podaci
- DOI
- 10.1371/journal.pone.0244689
- PMID
- 33606705
- PMCID
- PMC7895346
- Provjereno
- 2026-07-26
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