The DOI matches its Crossref record; 10 of the 10 references it cites were found in a registry or an index.
Cardiovascular prevention with glucose‐lowering drugs in type 2 diabetes: An evidence‐based approach to the categories of primary and secondary prevention
Open accessAbstract
AIMS: Whether to recommend specifically the glucose-lowering therapies with cardiovascular benefit only in secondary prevention, or also in patients with multiple risk factors (MRF) but without established atherosclerotic cardiovascular disease (ASCVD), is controversial across the guidelines for diabetes. MATERIALS AND METHODS: We performed a meta-analysis of clinical trials with major adverse cardiovascular events (MACE) as an outcome. RESULTS: The definitions of ASCVD and MRF were heterogeneous across trials; nevertheless, the incidence of MACE was 2.8-fold higher in people with ASCVD in trials with sodium-glucose cotransporter 2 inhibitors (SGLT2is), and 3.9-fold in trials with glucagon-like peptide-1 receptor agonists (GLP-1 RA). Both SGLT2i and GLP-1 RA were associated with a significant reduction in the incidence of MACE in people with previous ASCVD [inverse variance-odds ratio 0.91, 95% confidence interval (0.86: 0.97) for SGLT2i, Mantel-Haenszel odds ratio 0.85, 95% confidence interval (0.81: 0.90) for GLP-1 RA], whereas no significant reduction was detected in those without; on the other hand, no significant difference in effect was found between the two groups as well. The sample of patients without ASCVD enrolled in clinical trials is insufficient to draw reliable conclusions in this population; however, even assuming the same benefit detected in people with ASCVD also in those with MRF, the number needed to treat would differ (35 for secondary, 99 for primary prevention of a MACE with a SGLT2i; 21 for secondary, 82 for primary prevention with a GLP-1 RA, respectively), given the difference in absolute cardiovascular risk at baseline. CONCLUSION: The distinction between patients with ASCVD and those without ASCVD and MRF appears therefore justified by available evidence.
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The number needed to treat to prevent a major cardiovascular event among high-risk patients with diabetes is considerably smaller than the NNH for thyroid cancer.
“Conversely, figures for the number needed to treat to prevent a major cardiovascular event among high-risk patients with diabetes are considerably smaller.64”
From Glucagon‐like peptide‐1 receptor agonists and risk of thyroid cancer: A systematic review and meta‐analysis of randomized controlled trials (2024) · cites this paper as [64]
Citations
Cites
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Zinman, B., Wanner, C., Lachin, J. M., Fitchett, D., Bluhmki, E., Hantel, S., Mattheus, M., Devins, T., Johansen, O. E., Woerle, H. J., et al. (2015) · New England Journal of Medicine · doi:10.1056/nejmoa1504720 · Cited by 12,315
Liraglutide and Cardiovascular Outcomes in Type 2 Diabetes
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Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes
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Cardiovascular outcomes with ertugliflozin in type 2 diabetes
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Cholesterol Lowering in Intermediate-Risk Persons without Cardiovascular Disease
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“For pioglitazone, the only trial separately reporting data on MACE in patients without ASCVD is the TOSCA study 23 ; a post-hoc analysis on patients without ASCVD did not show any difference in MACE between pioglitazone and sulphonylurea [OR 0.99 (0.73-1.34)] in 2693 patients.”
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Silverii, G. A., Monami, M., Gallo, M., Ragni, A., Prattichizzo, F., Renzelli, V., Ceriello, A., & Mannucci, E. (2024) · Diabetes Obesity and Metabolism · doi:10.1111/dom.15382 · Cited by 113
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Metadata
- Authors
- Mannucci, E., & Silverii, G. A.
- Affiliations
- University of Florence (IT)
- Corresponding author
- Silverii, Giovanni Antonio
- Venue
- Diabetes, Obesity and Metabolism
- Publisher
- Wiley
- Published
- 2023-08-02
- Volume
- 25
- Issue
- 12
- Pages
- 3435-3443
- ISSN
- 1462-8902 (ISSN-L)
- 1463-1326
- OpenAlex
- W4385476384
- Cited by
- 16
- References
- 10
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 5 · 2023: 2
- FWCI
- 0.58
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Diabetes Obesity and Metabolism (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Florence Research (University of Florence) (submittedVersion, cc-by-nc)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- type 2 diabetes, cardiovascular disease prevention, major adverse cardiovascular events, SGLT2 inhibitors, GLP-1 receptor agonists, atherosclerotic cardiovascular disease, multiple risk factors, primary prevention, secondary prevention, number needed to treat, cardiovascular risk stratification
- MeSH terms
- Glucagon-Like Peptide-1 Receptor, Sodium-Glucose Transporter 2 Inhibitors, Glucagon-Like Peptide-1 Receptor Agonists, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Glucose, Humans, Hypoglycemic Agents, Atherosclerosis, Glucagon-Like Peptide 1, Secondary Prevention
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