Background In recent years, the incidence of diabetes mellitus has been increasing annually, and cardiovascular complications secondary to diabetes mellitus have become the leading cause of death in diabetic patients. Considering the high incidence of type 2 diabetes (T2DM) combined with cardiovascular disease (CVD), some new hypoglycemic agents with cardiovascular protective effects have attracted extensive attention. However, the specific role of these regimens in ventricular remodeling remains unknown. The purpose of this network meta-analysis was to compare the effects of sodium glucose cotransporter type 2 inhibitor (SGLT-2i), glucagon-like peptide 1 receptor agonist (GLP-1RA) and dipeptidyl peptidase-4 inhibitor (DPP-4i) on ventricular remodeling in patients with T2DM and/or CVD. Methods Articles published prior to 24 August 2022 were retrieved in four electronic databases: the Cochrane Library, Embase, PubMed, and Web of Science. This meta-analysis included randomized controlled trials (RCTs) and a small number of cohort studies. The differences in mean changes of left ventricular ultrasonic parameters between the treatment and control groups were compared. Results A total of 31 RCTs and 4 cohort studies involving 4322 patients were analyzed. GLP-1RA was more significantly associated with improvement in left ventricular end-systolic diameter (LVESD) [MD = -0.38 mm, 95% CI (-0.66, -0.10)] and LV mass index (LVMI) [MD = -1.07 g/m2, 95% CI (-1.71, -0.42)], but significantly decreased e' [MD = -0.43 cm/s 95% CI (-0.81, -0.04)]. DPP-4i was more strongly associated with improvement in e' [MD = 3.82 cm/s, 95% CI (2.92,4.7)] and E/e'[MD = -5.97 95% CI (-10.35, -1.59)], but significantly inhibited LV ejection fraction (LVEF) [MD = -0.89% 95% CI (-1.76, -0.03)]. SGLT-2i significantly improved LVMI [MD = -0.28 g/m2, 95% CI (-0.43, -0.12)] and LV end-diastolic diameter (LVEDD) [MD = -0.72 ml, 95% CI (-1.30, -0.14)] in the overall population, as well as E/e' and SBP in T2DM patients combined with CVD, without showing any negative effect on left ventricular function. Conclusion The results of the network meta-analysis provided high certainty to suggest that SGLT-2i may be more effective in cardiac remodeling compared to GLP-1RA and DPP-4i. While GLP-1RA and DPP-4i may have a tendency to improve cardiac systolic and diastolic function respectively. SGLT-2i is the most recommended drug for reversing ventricular remodeling in this meta-analysis.

Background:Observational studies have suggested associations between sleep duration and atherosclerosis(AS).However,it’s role as a risk factor or as a subeffect because of atherosclerosis is uncertain.Methods:We performed a literature search of genome-wide studies that evaluate sleep duration.We used a two -sample Mendelian randomization approach to evaluate the causality of sleep duration on atherosclerosis risk,using 2 cohorts:MRC-IEU (n=460,099)and UK Biobank(n=361,194).The two-sample MR study was conducted to estimate causal relationship between sleep duration and AS,with the inverse-variance weighted (IVW)method,Robust adjusted profile score (RAPS),simple-and weighted-median method.Moreover,MR-Egger regression,RadialMR,MR-PRESSO and leave-one-out analysis were performed to evaluate the potential pleiotropy effect.Results:Genome-wide association studies of sleep duration were evaluated.No associations were found in relation to atherosclerosis(odds ratio=0.90[95% CI,0.98-1.00];p-value=1.86×10−1).MR-Egger,MR-PRESSO,and leave-one-out analysis did not indicate horizontal pleiotropy.Conclusion:Our MR study suggested that genetically predicted sleep duration was not causally associated with AS among the European populations.

Background In recent years, the incidence of diabetes mellitus has been increasing annually and cardiovascular complications secondary to diabetes mellitus have become the main cause of death in diabetic patients. Although some novel glucose-lowering drugs have been shown to be cardioprotective, it is unclear which glucose-lowering drugs are effective in improving cardiac remodeling and fundamentally delay the progression of heart failure. The purpose of this network meta-analysis was to compare the effects of sodium glucose cotransporter type 2 inhibitor (SGLT-2i), glucagon-like peptide 1 receptor agonist (GLP-1RA) and dipeptidyl peptidase-4 inhibitor (DPP-4i) on ventricular remodeling in patients with type 2 diabetes (T2DM) and/or cardiovascular disease (CVD). Methods Articles published prior to 24 August 2022 were retrieved in four electronic databases: PubMed, EMBASE, Cochrane Library, and Web of Science. We included randomized controlled trials (RCTs) and a small cohort study in this meta-analysis. The differences of mean changes of left ventricular ultrasonic parameters between the treatment group and the control group were compared. Results A total of 31 RCTs and 4 cohort studies involving 4322 patients were analyzed. SGLT-2i had significantly reduced left ventricular end-diastolic diameter (LVEDD) [MD=-0.72ml, 95% CI (-1.30, -0.14)] and LV mass index (LVMI) [MD=-0.28g/m2, 95% CI (-0.43, -0.12)]. GLP-1RA had significantly reduced LV end-systolic diameter (LVESD) [MD=-0.38mm, 95% CI (-0.66, -0.10)], LVMI [MD=-1.07g/m2, 95% CI (-1.71, -0.42)], and e' [MD=-0.43cm/s 95% CI (-0.81, -0.04)]. DPP-4i significantly improved e' [MD=3.82cm/s, 95%CI (2.92,4.7)] and E/e' [MD = -5.97 95% CI (-10.35, -1.59)], but decreased LV ejection fraction (LVEF) [MD = -0.89% 95% CI (-1.76, -0.03)]. Conculusion GLP-1RA were more significantly associated with improvement in LVESD and LVMI, but significantly decreased e'. DPP-4i were more strongly associated with improvement in e' and E/e', but significantly inhibited LVEF. SGLT-2i significantly improved LVMI and LVEDD in the overall population, as well as E/e' and SBP in T2DM patients combined with CVD, without showing any negative effect on left ventricular function. Therefore, we recommend SGLT-2i as the most effective drug for reversing ventricular remodeling.