Author + information
- Xiaodong Zhuang,
- Xin He,
- Daya Yang,
- Zhimin Du and
- Xinxue Liao
Background: The benefits and risks for cardiovascular (CV) outcomes of using one anti-diabetic medication over another remain largely unknown. Therefore, we performed a network meta-analysis to assess the comparative effect on CV outcomes among novel anti-diabetic agents, namely, the dipeptidyl peptidase 4 (DPP-4) inhibitors, the glucagon-like peptide-1 (GLP-1) receptor agonists, and the sodium-glucose co-transporter 2 (SGLT-2) inhibitors.
Methods: Electronic databases were searched for randomized controlled trials comparing novel anti-diabetic drugs with other comparators in adults with type 2 diabetes. Primary outcomes were major adverse cardiovascular events (MACEs). Estimates for outcomes were presented as odds ratios (ORs) with 95% Confidence Intervals (CIs). Additional correlation analysis of severe hypoglycemia and MACEs according to the ranking order was conducted.
Results: 149 trials with 145,884 participants were included. No single anti-diabetic drug was significantly better than placebo for MACEs. By class, sulfonylureas (OR 1.28, 95%CI 0.60-2.73) ranked the lowest and SGLT-2 inhibitors, GLP-1 receptor agonists and DPP-4 inhibitors were significantly better than sulfonylureas. By individual, sulfonylureas (OR 1.40, 95%CI 0.65-3.00) ranked the lowest, where Vildagliptin, Empagliflozin, Lixisenatide, Exenatide, Canagliflozin, Sitagliptin were significantly better than sulfonylureas. Moreover, sulfonylureas were associated with the highest risk of severe hypoglycemia (OR 6.75, 95%CI 1.39-32.72). Ranking order of MACEs risk was positively correlated with the ranking order of severe hypoglycemia risk both by class and by individual (p=0.002; p=0.001, respectively).
Conclusions: All three classes of novel anti-diabetic agents possess favorable cardiovascular safety profile. In addition, sulfonylureas were associated with the highest risk of MACEs, which was potentially explained by its concomitant increase in the risk of severe hypoglycemia. These results should be considered in policy-making in health care as well as the development of clinical practice guidelines.
Moderated Poster Contributions
Prevention Moderated Poster Theater, Poster Hall, Hall C
Saturday, March 18, 2017, 1:15 p.m.-1:25 p.m.
Session Title: The Intersection of Diabetes and ASCVD
Abstract Category: 32. Prevention: Clinical
Presentation Number: 1222M-09
- 2017 American College of Cardiology Foundation