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Meta-Analysis
. 2022 Dec;42(12):921-928.
doi: 10.1002/phar.2737. Epub 2022 Nov 4.

Effects of GLP-1 receptor agonists on cardiovascular outcomes in patients with type 2 diabetes and chronic kidney disease: A systematic review and meta-analysis

Michael Kelly  1 , Jelena Lewis  2 , Hindu Rao  2 , Jessica Carter  2 , Ivan Portillo  2 , Richard Beuttler  2
Affiliations
Meta-Analysis

Effects of GLP-1 receptor agonists on cardiovascular outcomes in patients with type 2 diabetes and chronic kidney disease: A systematic review and meta-analysis

Michael Kelly et al. Pharmacotherapy. 2022 Dec.

Abstract

Aim: To evaluate the cardiovascular outcomes of glucagon-like peptide-1 receptor agonists (GLP1-RA) in patients with type 2 diabetes (T2DM) and chronic kidney disease (CKD).

Materials and methods: We searched PubMed, Ovid MEDLINE, CINAHL, and Web of Science databases for randomized controlled trials reporting event rates for a composite cardiovascular outcome of cardiovascular death, myocardial infarction, and stroke in patients with T2DM and CKD receiving GLP1-RA or placebo. Studies were restricted to those reporting specific event rates for patients with CKD separately from the overall population. We conducted a meta-analysis using a random-effects model. This meta-analysis was registered on PROSPERO (CRD42022320157).

Results: A total of four studies comprising 7130 patients was included in our analysis. Four different GLP1-RA were assessed in a population with CKD defined as estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2 . Treatment with GLP1-RA was not associated with a significant reduction in the composite cardiovascular end point of cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke (odds ratio (OR) 0.80; 95% confidence interval (CI), 0.59-1.07; p = 0.13) among patients with T2DM and CKD. Individual components of the composite cardiovascular end point were assessed in two trials and did not show evidence of an effect of GLP1-RA in reducing cardiovascular end points.

Conclusions: Pooled analysis of clinical trials reporting separate cardiovascular events rates in patients with T2DM and CKD did not find GLP1-RA to be associated with a reduction in composite cardiovascular event rates. Select GLP1-RA may offer cardiovascular event reduction in patients with T2DM and CKD, but this does not appear to be a class effect. Use of GLP1-RA with demonstrated cardiovascular benefits should be preferred in patients with CKD and T2DM to further reduce cardiovascular risk.

Keywords: GLP-1 receptor agonist; cardiovascular disease; chronic kidney disease; diabetes.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Preferred Reporting Items for Systematic Review and Meta‐Analysis (PRISMA) flow diagram of identified studies. CKD, chronic kidney disease; CINAHL, Cumulative Index to Nursing and Allied Health Literature; GLP1‐RA, glucagon‐like peptide‐1 receptor agonists; OVID, Offshore Vessel Inspection Database; RCT, randomized controlled trial
FIGURE 2
FIGURE 2
Composite cardiovascular outcomes. CI, confidence interval; GLP1, glucagon‐like peptide‐1; OR, odds ratio
FIGURE 3
FIGURE 3
Cardiovascular death, myocardial infarction, and stroke individual outcomes. CI, confidence interval; GLP1, glucagon‐like peptide‐1; OR = odds ratio
See this image and copyright information in PMC

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