Glucose-Lowering and the Risk of Cardiovascular Events With Antidiabetic Therapies: A Systematic Review and Additive-Effects Network Meta-Analysis.

Autor:	de Carvalho LSF; Laboratory of Data for Quality of Care and Outcomes Research, Clarity Healthcare Intelligence, Jundiaí, Brazil.; Catholic University of Brasília (UCB), Brasilia, Brazil.; Atherosclerosis and Vascular Biology Laboratory (Atherolab), Cardiology Division, University of Campinas (Unicamp), Campinas, Brazil., Nogueira ACC; Catholic University of Brasília (UCB), Brasilia, Brazil.; Atherosclerosis and Vascular Biology Laboratory (Atherolab), Cardiology Division, University of Campinas (Unicamp), Campinas, Brazil., Bonilha I; Catholic University of Brasília (UCB), Brasilia, Brazil., Luchiari B; Atherosclerosis and Vascular Biology Laboratory (Atherolab), Cardiology Division, University of Campinas (Unicamp), Campinas, Brazil., Benchimol A; Cardiology Department, State Institute of Diabetes and Endocrinology, Rio de Janeiro, Brazil., Couri CEB; Department of Hematology, University of São Paulo, São Paulo, Brazil., Borges JL; São Paulo Federal University (UNIFESP), São Paulo, Brazil., Barreto J; Atherosclerosis and Vascular Biology Laboratory (Atherolab), Cardiology Division, University of Campinas (Unicamp), Campinas, Brazil., Sposito AC; Atherosclerosis and Vascular Biology Laboratory (Atherolab), Cardiology Division, University of Campinas (Unicamp), Campinas, Brazil.
Jazyk:	angličtina
Zdroj:	Frontiers in cardiovascular medicine [Front Cardiovasc Med] 2022 Apr 29; Vol. 9, pp. 876795. Date of Electronic Publication: 2022 Apr 29 (Print Publication: 2022).
DOI:	10.3389/fcvm.2022.876795
Abstrakt:	Aim: To assess the impact of the HbA1c levels achieved with antidiabetic therapies (ADTs) on the risk of MACE. Methods: A systematic search was performed in PubMed, Cochrane, and ClinicalTrials. gov for RCTs published up to March 2022 reporting the occurrence of MACE and all-cause mortality in individuals with T2DM treated with all marketed ADTs, including a sample size ≥100 individuals in each study arm and follow-up ≥24 weeks. A systematic review and additive-effects network meta-analysis with random effects and a multivariate meta-regression were utilized to assess the impact of achieved HbA1c on incident MACE. Results: We included 126 RCTs with 143 treatment arms, 270,874 individuals, and 740,295 individuals-years who were randomized to an active treatment vs. control group. Among all ADTs, only therapy with SGLT2i, GLP1-RA, or pioglitazone similarly reduced the risk of MACE compared to placebo. The achievement of HbA1c ≤ 7.0% in RCTs with the 3 drug classes in the active arm was associated with an adjusted HR of 0.91 (95% CI 0.80, 0.97; p = 0.017) compared with HbA1c>7.0%, without affecting all-cause mortality. These results, however, were not maintained among all ADTs. Conclusions: Achieving lower glucose levels with SGLT2i, GLP1-RA, or pioglitazone is linearly associated with a reduced risk of MACEs, without affecting all-cause mortality. Systematic Review Registration: www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020213127, identifier: CRD42020213127. Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2022 Carvalho, Nogueira, Bonilha, Luchiari, Benchimol, Couri, Borges, Barreto and Sposito.)
Databáze:	MEDLINE
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