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Review
. 2023 May 19:47:101218.
doi: 10.1016/j.ijcha.2023.101218. eCollection 2023 Aug.

Effects of GLP-1 Agonists on mortality and arrhythmias in patients with Type II diabetes

Mohammed A Al-Sadawi  1 , Faisal M Aslam  1 , Michael Tao  1 , Mahmoud Alsaiqali  2 , Ibrahim O Almasry  1 , Roger Fan  1 , Eric J Rashba  1 , Abhijeet Singh  1
Affiliations
Review

Effects of GLP-1 Agonists on mortality and arrhythmias in patients with Type II diabetes

Mohammed A Al-Sadawi et al. Int J Cardiol Heart Vasc. .

Abstract

Background: Glucagon-like Peptide-1 Receptor Agonists (GLP-1 RA) are frequently used for the management of diabetes. The impact of GLP-1 RA on cardiovascular outcomes is unclear. We aim to assess the effect of GLP-1 RA on mortality, atrial and ventricular arrhythmias, and sudden cardiac death in patients with type II diabetes.

Methods: We searched databases including Ovid MEDLINE, EMBASE, Scopus, Web of Science, Google Scholar and CINAHL, from inception to May 2022, for randomized controlled trials reporting the relationship between GLP-1 RA (including albiglutide, dulaglutide, exenatide, liraglutide, lixisenatide, and semaglutide) and mortality, atrial arrhythmias, and the combined incidence of ventricular arrhythmias and sudden cardiac death. The search was not restricted to time or publication status.

Results: A total of 464 studies resulted from literature search, of which 44 studies, including 78,702 patients (41,800 GLP-1 agonists vs 36,902 control), were included. Follow up ranged from 52 to 208 weeks. GLP-1 RA were associated with lower risk of all-cause mortality (odds ratio 0.891, 95% confidence interval 0.837-0.949; P < 0.01) and reduced cardiovascular mortality (odds ratio 0.88, 95% confidence interval 0.881-0.954; P < 0.01). GLP-1 RA were not associated with increased risk of atrial (odds ratio 0.963, 95% confidence interval 0.869-1.066; P 0.46) or ventricular arrhythmias and sudden cardiac death (odds ratio 0.895, 95% confidence interval 0.706-1.135; P 0.36).

Conclusion: GLP-1 RA are associated with decreased all-cause and cardiovascular mortality, and no increased risk of atrial and ventricular arrhythmias and sudden cardiac death.

Keywords: Arrhythmias; GLP-1 agonists; Mortality; Outcomes; Sudden cardiac death.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
PRISMA Flow Chart. Flow diagram depicts study selection for inclusion in the meta-analysis according to the PRISMA statement for reporting systematic reviews and meta-analyses.
Fig. 2
Fig. 2
Forest plot showing Association between GLP-1 RA and all-cause mortality: Using GLP-1 RA therapy in patients with DM2 was associated with lower all-cause mortality (odds ratio 0.891, 95% confidence interval 0.837–0.949; P < 0.01) compared to controls. Heterogeneity is low: df = 37 (P 0.697), I2 = 0; Test for overall effect: Z = -3.61 (P < 0.001).
Fig. 3
Fig. 3
Forest plot showing Association between GLP-1 RA and cardiovascular mortality: Using GLP-1 RA therapy in patients with DM2 was associated with lower cardiovascular mortality (odds ratio 0.88, 95% confidence interval 0.881–0.954; P < 0.01) compared to controls. Heterogeneity is low: df = 21 (P 0.776), I2 = 0; Test for overall effect: Z = -3.11 (P = 0.002).
Fig. 4
Fig. 4
Forest plot showing Association between GLP-1 RA and ventricular arrhythmias and/or sudden cardiac death: Using GLP-1 RA therapy in patients with DM2 was not associated with increased risk of ventricular arrhythmias and/or sudden cardiac death (odds ratio 0.895, 95% confidence interval 0.706–1.135; P 0.36) compared to controls. Heterogeneity is low: df = 5 (P 0.479), I2 = 0; Test for overall effect: Z = −0.913 (P = 0.36).
Fig. 5
Fig. 5
Forest plot showing Association between GLP-1 RA and atrial arrhythmias: Using GLP-1 RA therapy in patients with DM2 was not associated with increased risk of atrial arrhythmias (odds ratio 0.963, 95% confidence interval 0.869–1.066; P 0.46) compared to controls. Heterogeneity is low: df = 24 (P 0.72), I2 = 0; Test for overall effect: Z = −0.69 (P = 0.49).
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References

    1. Diabetes Mellitus, Fasting Glucose, and Risk of Cause-Specific Death. New Engl. J. Med. 2011;364(9):829-841. doi: https://doi.org/10.1056/NEJMOA1008862/SUPPL_FILE/NEJMOA1008862_DISCLOSUR.... - PMC - PubMed
    1. Bell D.S.H., Goncalves E. Atrial fibrillation and type 2 diabetes: Prevalence, etiology, pathophysiology and effect of anti-diabetic therapies. Diabetes. Obes. Metab. 2019;21(2):210–217. doi: 10.1111/DOM.13512. - DOI - PubMed
    1. McMurray J.J.V., Solomon S.D., Inzucchi S.E., et al. Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction. N. Engl. J. Med. 2019;381(21):1995–2008. doi: 10.1056/NEJMOA1911303. - DOI - PubMed
    1. Packer M., Anker S.D., Butler J., et al. Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure. N. Engl. J. Med. 2020;383(15):1413–1424. doi: 10.1056/NEJMOA2022190. - DOI - PubMed
    1. Anker S.D., Butler J., Filippatos G., et al. Empagliflozin in Heart Failure with a Preserved Ejection Fraction. N. Engl. J. Med. 2021;385(16):1451–1461. doi: 10.1056/NEJMOA2107038. - DOI - PubMed

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