Meta-Analysis

. 2016 May 11:16:91.

doi: 10.1186/s12872-016-0260-0.

Glucagon-like peptide-1 receptor agonists and heart failure in type 2 diabetes: systematic review and meta-analysis of randomized and observational studies

Ling Li¹, Sheyu Li², Jiali Liu¹, Ke Deng³, Jason W Busse^{4

5

6}, Per Olav Vandvik^{7

8}, Evelyn Wong⁹, Zahra N Sohani^{4

10}, Malgorzata M Bala^{11

12}, Lorena P Rios¹³, German Malaga¹⁴, Shanil Ebrahim^{4

5

15

16}, Jiantong Shen¹, Longhao Zhang¹, Pujing Zhao¹, Qunfei Chen¹⁷, Yingqiang Wang¹⁸, Gordon H Guyatt^{4

19}, Xin Sun²⁰

Affiliations

¹ Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, 37 GuoXue Xiang, Chengdu, 610041, Sichuan, China.
² Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
³ West China school of Pharmacy, Sichuan University, Chengdu, Sichuan, China.
⁴ Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
⁵ Department of Anesthesia, McMaster University, Hamilton, ON, Canada.
⁶ The Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON, Canada.
⁷ Norwegian Knowledge Centre for the Health Services, Oslo, Norway.
⁸ Department of Medicine, Innlandet Hospital Trust, Gjøvik, Norway.
⁹ Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
¹⁰ Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, Canada.
¹¹ Department of Hygiene and Dietetics, Jagiellonian University Medical College, Krakow, Poland.
¹² Systematic Reviews Unit-Polish Cochrane Branch, Jagiellonian University Medical College, Krakow, Poland.
¹³ Internal Medicine Unit, Hospital Clinico FUSAT, Rancagua, Chile.
¹⁴ Department of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru.
¹⁵ Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, USA.
¹⁶ Department of Anaesthesia & Pain Medicine, The Hospital for Sick Children, Toronto, ON, Canada.
¹⁷ The Second Hospital of Lanzhou University, Lanzhou, China.
¹⁸ Department of Medical Administration, 363 Hospital, Chengdu, Sichuan, China.
¹⁹ Department of Medicine, McMaster University, Hamilton, ON, Canada.
²⁰ Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, 37 GuoXue Xiang, Chengdu, 610041, Sichuan, China. sunx79@hotmail.com.

PMID: 27169565
PMCID: PMC4863354
DOI: 10.1186/s12872-016-0260-0

Meta-Analysis

Glucagon-like peptide-1 receptor agonists and heart failure in type 2 diabetes: systematic review and meta-analysis of randomized and observational studies

Ling Li et al. BMC Cardiovasc Disord. 2016.

. 2016 May 11:16:91.

doi: 10.1186/s12872-016-0260-0.

Authors

Affiliations

¹ Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, 37 GuoXue Xiang, Chengdu, 610041, Sichuan, China.
² Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
³ West China school of Pharmacy, Sichuan University, Chengdu, Sichuan, China.
⁴ Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
⁵ Department of Anesthesia, McMaster University, Hamilton, ON, Canada.
⁶ The Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON, Canada.
⁷ Norwegian Knowledge Centre for the Health Services, Oslo, Norway.
⁸ Department of Medicine, Innlandet Hospital Trust, Gjøvik, Norway.
⁹ Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
¹⁰ Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, Canada.
¹¹ Department of Hygiene and Dietetics, Jagiellonian University Medical College, Krakow, Poland.
¹² Systematic Reviews Unit-Polish Cochrane Branch, Jagiellonian University Medical College, Krakow, Poland.
¹³ Internal Medicine Unit, Hospital Clinico FUSAT, Rancagua, Chile.
¹⁴ Department of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru.
¹⁵ Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, USA.
¹⁶ Department of Anaesthesia & Pain Medicine, The Hospital for Sick Children, Toronto, ON, Canada.
¹⁷ The Second Hospital of Lanzhou University, Lanzhou, China.
¹⁸ Department of Medical Administration, 363 Hospital, Chengdu, Sichuan, China.
¹⁹ Department of Medicine, McMaster University, Hamilton, ON, Canada.
²⁰ Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, 37 GuoXue Xiang, Chengdu, 610041, Sichuan, China. sunx79@hotmail.com.

PMID: 27169565
PMCID: PMC4863354
DOI: 10.1186/s12872-016-0260-0

Abstract

Background: The effect of glucagon-like peptide-1(GLP-1) receptor agonists on heart failure remains uncertain. We therefore conducted a systematic review to assess the possible impact of GLP-1 agonists on heart failure or hospitalization for heart failure in patients with type 2 diabetes.

Methods: We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL) and ClinicalTrials.gov to identify randomized controlled trials (RCTs) and observational studies that addressed the effect of GLP-1 receptor agonists in adults with type 2 diabetes, and explicitly reported heart failure or hospitalization for heart failure. Two paired reviewers screened reports, collected data, and assessed the risk of bias. We pooled data from RCTs and observational studies separately, and used the GRADE approach to rate the quality of evidence.

Results: We identified 25 studies that were eligible for our review; 21 RCTs (n = 18,270) and 4 observational studies (n = 111,029). Low quality evidence from 20 RCTs suggested, if anything, a lower incidence of heart failure between GLP-1 agonists versus control (17/7,441 vs. 19/4,317; odds ratio (OR) 0.62, 95 % confidence interval (CI) 0.31 to 1.22; risk difference (RD) 19 fewer, 95 % CI 34 fewer to 11 more per 1000 over 5 years). Three cohort studies comparing GLP-1 agonists to alternative agents provided very low quality evidence that GLP-1 agonists do not increase the incidence of heart failure. One RCT provided moderate quality evidence that GLP-1 agonists were not associated with hospitalization for heart failure (lixisenatide vs placebo: 122/3,034 vs. 127/3,034; adjusted hazard ratio 0.96, 95 % CI 0.75 to 1.23; RD 4 fewer, 95 % CI 25 fewer to 23 more per 1000 over 5 years) and a case-control study provided very low quality evidence also suggesting no association (GLP-1 agonists vs. other anti-hyperglycemic drugs: 1118 cases and 17,626 controls, adjusted OR 0.67, 95 % CI 0.32 to 1.42).

Conclusions: The current evidence suggests that GLP-1 agonists do not increase the risk of heart failure or hospitalization for heart failure among patients with type 2 diabetes.

Keywords: Glucagon-like peptide-1 receptor; Heart failure; Meta-analysis; Systematic review; Type 2 diabetes.

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Figures

**Fig. 1**
Flow chart of article selection

**Fig. 2**
Risk of heart failure in patients who received GLP-1 agonists versus control from randomized controlled trials

**Fig. 3**
Risk of heart failure in patients who received GLP-1 agonists versus control based on adjusted data of observational studies

See this image and copyright information in PMC

References

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Glucagon-like peptide-1 receptor agonists and heart failure in type 2 diabetes: systematic review and meta-analysis of randomized and observational studies

Affiliations

Glucagon-like peptide-1 receptor agonists and heart failure in type 2 diabetes: systematic review and meta-analysis of randomized and observational studies

Authors

Affiliations

Abstract

Figures

References

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MeSH terms

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LinkOut - more resources

Full Text Sources

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Medical

Miscellaneous