Glucose-lowering Drugs and Hospitalization for Heart Failure: A Systematic Review and Additive-effects Network Meta-analysis With More Than 500 000 Patient-years.
J Clin Endocrinol Metab
; 106(10): 3060-3067, 2021 09 27.
Article
em En
| MEDLINE
| ID: mdl-34125217
ABSTRACT
BACKGROUND:
Sodium glucose co-transporter 2 inhibitors (SGLT2is) prevent hospitalization resulting from heart failure (HHF). However, patients with type 2 diabetes mellitus use multiple antihyperglycemic drugs to achieve glycosylated hemoglobin (HbA1c) targets. In these drug combinations, the risk of HHF is unpredictable and so is the parallel effect of glucose-lowering.PURPOSE:
To examine the impact of antihyperglycemic drugs and their association on HHF. DATA SOURCES Forty randomized controlled trials (RCTs) reporting HHF. STUDY SELECTION Published RCTs were the data source. DATA EXTRACTION Incidence rates of HHF. DATASYNTHESIS:
Random additive-effects network meta-analysis showed that metformin (Pâ =â 0.55), sulfonylureas (Pâ =â 0.51), glucagon-like peptide-1 receptor-agonist (Pâ =â 0.16), and dipeptidyl peptidase 4 inhibitors (DPP4is; Pâ =â 0.54) were neutral on the risk of HHF. SGLT2is and SGLT2isâ +â DPP4is reduced the risk of HHF with a hazard ratio (HR) of 0.68 (95% CI, 0.60-0.76; Pâ <â 0.0001) and 0.70 (95% CI, 0.60-0.81; Pâ <â 0.0001), respectively. Increased risk of HHF was associated with thiazolidinediones (TZDs) as monotherapy or in combination with DPP4is (HR 1.45; 95% CI, 1.18-1.78; Pâ =â 0.0004) and 1.49 (95% CI, 1.18-1.88; Pâ =â 0.0008), respectively. Regardless of the therapy, a 1% reduction in HbA1c reduced the risk of HHF by 31.3% (95% CI, 9-48; Pâ =â 0.009).LIMITATIONS:
There are no data to verify drug combinations available for clinical use and to discriminate the effect of drugs within each of the therapeutic classes.CONCLUSIONS:
The risk of HHF is reduced by SGLT2is as monotherapy or in combination with DPP4is and increased by TZDs as monotherapy or in combination. Glucose-lowering provides an additive effect of reducing HHF.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Diabetes Mellitus Tipo 2
/
Cardiomiopatias Diabéticas
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Insuficiência Cardíaca
/
Hospitalização
/
Hipoglicemiantes
Tipo de estudo:
Clinical_trials
/
Etiology_studies
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Incidence_studies
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Prognostic_studies
/
Systematic_reviews
Limite:
Female
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Humans
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Male
/
Middle aged
Idioma:
En
Ano de publicação:
2021
Tipo de documento:
Article