5 :: KDA, Korean Diabetes Association ::
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Subject    :    [2019 Aug;43(4)] Asian Subpopulations May Exhibit Greater Cardiovascular Benefit from Long-Acting Glucagon-Like Peptide 1 Receptor Agonists: A Meta-Analysis of Cardiovascular Outcome Trials
Writer KDA
Date 2019-10-10 16:38:06 Hit 691
LINK URL https://e-dmj.org/search.php?where=aview&id=10.4093/dmj.2018.0070&code=2004DMJ&vmode=FULL (Click 10)
Diabetes Metab J. 2019 Aug;43(4):410-421. English.
Published online Dec 27, 2018.  https://doi.org/10.4093/dmj.2018.0070
Copyright © 2019 Korean Diabetes Association
   
Asian Subpopulations May Exhibit Greater Cardiovascular Benefit from Long-Acting Glucagon-Like Peptide 1 Receptor Agonists: A Meta-Analysis of Cardiovascular Outcome Trials
Yu Mi Kang,1,* Yun Kyung Cho,2,* Jiwoo Lee,2 Seung Eun Lee,2 Woo Je Lee,2 Joong-Yeol Park,2 Ye-Jee Kim,3 Chang Hee Jung,2 and Michael A. Nauck4
1International Healthcare Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
2Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
3Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
4Diabetes Center Bochum-Hattingen, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.

Corresponding author: Chang Hee Jung. Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea. Email: chjung0204@amc.seoul.kr Corresponding author: Michael A. Nauck. Diabetes Center Bochum-Hattingen, Medical Department I, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstraße 56, 44791 Bochum, Germany. Email: Michael.nauck@rub.de

 

*Yu Mi Kang and Yun Kyung Cho contributed equally to this study as first authors.
 
Received April 24, 2018; Accepted November 29, 2018.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.



Abstract

Background

Based on reported results of three large cardiovascular outcome trials (CVOTs) of glucagon-like peptide 1 receptor agonists (GLP-1 RAs), we aimed to investigate the overall effect of GLP-1 RAs on major adverse cardiovascular events (MACEs) and to identify subpopulations exhibiting the greatest cardiovascular (CV) benefit.

Methods

Three CVOTs reporting effects of long-acting GLP-1 RAs were included: LEADER (liraglutide), SUSTAIN-6 (semaglutide), and EXSCEL (exenatide once weekly). In all studies, the primary endpoint was three-point MACE, comprising CV death, non-fatal myocardial infarction, and non-fatal stroke. Overall effect estimates were calculated as hazard ratios and 95% confidence intervals (CIs) using the random-effects model; subgroup analyses reported in the original studies were similarly analyzed.

Results

Overall, statistically significant risk reductions in MACE and CV death were observed. Subgroup analysis indicated a significant racial difference with respect to CV benefit (P for interaction <0.001), and more substantial risk reductions were observed in subjects of African origin (relative risk [RR], 0.78; 95% CI, 0.60 to 0.99) and in Asians (RR, 0.35; 95% CI, 0.09 to 1.32). However, post hoc analysis (Bonferroni method) revealed that only Asians exhibited a significantly greater CV benefit from treatment, compared with white subjects (P<0.0001).

Conclusion

Long-acting GLP-1 RAs reduced risks of MACE and CV deaths in high-risk patients with type 2 diabetes mellitus. Our findings of a particularly effective reduction in CV events with GLP-1 RA in Asian populations merits further exploration and dedicated trials in specific populations.

   
Keywords:
Agonist; Cardiovascular disease; Diabetes mellitus, type 2; Glucagon-like peptide 1; Incretins; Meta-analysis; Safety; Therapeutics

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