SGLT2is vs. GLP1RAs Reduce Cardiovascular and All-Cause Mortality

Abstract

Lin et al. recently did a network meta-analysis based on cardiovascular (CV) outcome trials (CVOTs) of sodium-glucose cotransporter 2 inhibitors (SGLT2is) and those of glucagon-like peptide-1 receptor agonists (GLP1RAs). Due to the absence of CVOTs directly comparing SGLT2is with GLP1RAs, Lin et al.'s network meta-analysis identified the indirect evidence that SGLT2is vs. GLP1RAs reduced hospitalization for heart failure (HHF) but did not reduce CV death and all-cause mortality (ACM) in patients with type 2 diabetes (T2D). We did another meta-analysis incorporating those CV outcome cohort studies directly comparing SGLT2is with GLP1RAs, and identified that SGLT2is vs. GLP1RAs were significantly associated with the lower risks of not only HHF but also CV death and ACM. These findings may suggest that SGLT2is should be considered over GLP1RAs in terms of preventing CV and all-cause death and HHF in T2D patients.

Commentary: SGLT2is vs. GLP1RAs reduce cardiovascular and all-cause mortality

“…This also suggests the necessity of performing an updated meta-analysis in which more studies could be included in order to provide greater statistical power. Hence, we carried out an updated meta-analysis and aimed at confirming and updating the findings of Qiu's et al ( 1 ) meta-analysis.…”

“…The studies eligible for inclusion were cohort studies directly comparing SGLT2is and GLP1RAs in cardio-renal endpoints in T2D patients. Seven endpoints of interest are the same as those in Qius et al ( 1 ) meta-analysis: stroke, hospitalization for heart failure (HHF), CKO, major adverse cardiovascular events (MACE), myocardial infarction (MI), CVDH, and ACM. CKO was defined as a composite of eGFR 50% reduction or lower than 60 ml/min/1.73 m 2 , micro- or macro-albuminuria, renal failure, dialysis, renal transplantation, or renal death; and MACE was defined as a composite of CVDH, MI, or stroke.…”

“…The outcome data were extracted from included studies independently by two authors, and any discrepancies between them were solved by discussing with a third author. Just like Qiu et al ( 1 ), we performed random-effects meta-analyses based on HRs and 95% CIs to derive conservative estimates for the relative effectiveness of SGLT2is and GLP1RAs. P <0.05 was considered as statistical significance.…”

“…By implementing a meta-analysis ( 1 ) based on nine large cohort studies ( 2 – 10 ) directly comparing cardiovascular and renal endpoints between sodium-glucose cotransporter 2 inhibitors (SGLT2is) and glucagon-like peptide 1 receptor agonists (GLP1RAs) in patients with type 2 diabetes (T2D), Qiu et al ( 1 ) identified an interesting and clinically relevant finding that compared with GLP1RAs, SGLT2is were associated with significantly decreased risks of cardiovascular death (CVDH) [hazard ratio (HR) 0.82, 95% confidence interval (CI) 0.68–0.99] and all-cause mortality (ACM) (HR 0.92, 95% CI 0.85–0.99). Nowadays, nine new relevant cohort studies ( 11 – 19 ) are available and yield some inconsistent findings.…”

“…For example, the studies by Fu et al ( 11 ) and Ueda et al ( 12 ) show similar risk of CVDH between SGLT2is and GLP1RAs, while the studies by Alkabbani et al ( 13 ) and Tang et al ( 14 ) show similar risk of ACM. Moreover, in Qiu's et al ( 1 ) meta-analysis only a few of studies were incorporated when some endpoints were assessed, such as composite kidney outcome (CKO). This also suggests the necessity of performing an updated meta-analysis in which more studies could be included in order to provide greater statistical power.…”