A meta-analysis is presented of cardiovascular outcome trials (CVOTs) comparing glucagon-like peptide-1 receptor agonists (GLP-1RA) versus placebo on cardiorenal outcomes in patients with type 2 diabetes mellitus (T2DM). We did an electronic search up to June 30, 2021, for eligible trials. We did a meta-analysis of available trial data using a random-effects model to calculate overall hazard ratios (HRs) and 95% CI (confidence intervals). We included data from 8 CVOTs and 60,080 patients (72.4% with established cardiovascular disease). GLP-1RA reduced major cardiovascular events (MACE) by 14% (HR = 0.86, 95% CI 0.79–0.94, P = 0.006) with a non-significant heterogeneity between subgroups of patients with and without cardiovascular disease (P = 0.127). GLP-1RA also reduced the risk of cardiovascular death by 13% (P = 0.016), nonfatal stroke by 16% (P = 0.007), hospitalization for heart failure by 10% (P = 0.023), all-cause mortality by 12% (P = 0.012), and the broad composite kidney outcome by 17% (P = 0.012), which was driven by a reduction in macroalbuminuria only (HR = 0.74, 0.67–0.82, P < 0.001). GLP-1RA have moderate benefits on MACE, and also reduce hospitalization for heart failure and all-cause mortality; they also have robust benefits on reducing the incidence of macroalbuminuria.

中文翻译：

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GLP-1 受体激动剂和 2 型糖尿病的心肾结局：对 8 种 CVOT 的更新荟萃分析

一项荟萃分析比较了胰高血糖素样肽-1 受体激动剂 (GLP-1RA) 与安慰剂对 2 型糖尿病 (T2DM) 患者心肾结果的心血管结果试验 (CVOT)。我们对符合条件的试验进行了电子搜索，直至 2021 年 6 月 30 日。我们使用随机效应模型对可用试验数据进行了荟萃分析，以计算总体风险比 (HR) 和 95% CI（置信区间）。我们纳入了来自 8 名 CVOT 和 60,080 名患者（72.4% 患有心血管疾病）的数据。GLP-1RA 将主要心血管事件 (MACE) 降低了 14% (HR = 0.86, 95% CI 0.79–0.94, P = 0.006)，在有和没有心血管疾病的患者亚组之间没有显着的异质性 (P = 0.127)。GLP-1RA 还将心血管死亡的风险降低了 13% (P = 0.016)，非致死性卒中降低 16% (P = 0.007)，心力衰竭住院率降低 10% (P = 0.023)，全因死亡率降低 12% (P = 0.012)，广泛复合肾脏结局降低 17% (P = 0.012) ），这仅由大量白蛋白尿的减少驱动（HR = 0.74, 0.67–0.82, P < 0.001）。GLP-1RA 对 MACE 有适度的益处，并且还可以减少因心力衰竭住院和全因死亡率；它们在降低大量白蛋白尿的发生率方面也有很大的好处。