GLUCAGON-LIKE PEPTIDE-1 RECEPTOR AGONISTS DO NOT DECREASE THE RISK FOR CORONARY REVASCULARIZATION IN PATIENTS WITH TYPE 2 DIABETES: A META-ANALYSIS OF CARDIOVASCULAR OUTCOME TRIALS

Abstract

Objective: Cardiovascular disease (CVD) is common among subjects with type 2 diabetes mellitus (T2DM), while it represents the main cause of death, accounting for half of deaths in this population. Prevalence of coronary artery disease (CAD) among diabetic subjects is relatively high, more than 20%. Glucagon-like peptide-1 receptor agonists (GLP-1RAs), a class of antidiabetics with established cardiovascular benefits for patients with T2DM, have been shown to decrease the risk for major adverse cardiovascular events, cardiovascular and all-cause mortality, while they have been shown to decrease the risk for fatal or non-fatal myocardial infarction; therefore they have been suggested as second-line treatment option for patients with T2DM and established atherosclerotic cardiovascular disease. Design and method: We searched PubMed from inception to September 1st, 2021, for the relevant cardiovascular outcome trials with GLP-1RAs in patients with T2DM, to pool data concerning coronary revascularization. We searched both published reports and supplementary appendices. We evaluated the surrogate outcome of coronary revascularization with GLP-1RAs versus placebo. Results: We pooled data from 5 trials in a total of 41,355 subjects with T2DM. GLP-1RA treatment compared to placebo did not have a significant effect on the risk for coronary revascularization (risk ratio = 0.95, 95% CI; 0.81 – 1.11, I2 = 77%, p = 0.51). No significant differences were observed during various subgroup analyses. Conclusions: Despite their established cardioprotective effects in high-risk patients with T2DM, GLP-1RAs do not seem to confer a significant risk reduction in terms of coronary revascularization. Additional analyses according to the type of revascularization procedure might provide interesting insights.