A systematic review and meta-analysis of the impact of GLP-1 receptor agonists and SGLT-2 inhibitors on cardiovascular outcomes in biologically healthy older adults
Open accessAbstract
Background: Unintentional weight loss is a hallmark of frailty and is associated with poor outcomes in older adults with type 2 diabetes. As such, the role of pharmacological therapies that facilitate weight loss – namely, sodium- glucose co-transporter-2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists – remains uncertain in fitter older adults. We performed a systematic review and meta-analysis to evaluate these agents on major adverse cardiovascular events (MACE) in older adults eligible for participation in cardiovascular outcome trials.Methods: A literature search was performed in MEDLINE, EMBASE, CINAHL, Cochrane Central Registry of Controlled Trials (CENTRAL) and CNKI from inception to 29 June 2020. A class-specific meta-analysis was conducted in older adults (>65 years at recruitment) and compared with the similar analysis in younger (<65 years) adults.Results: Of 761 unique studies identified, nine met the criteria for inclusion, five using GLP-1 receptor agonists and four with SGLT-2 inhibitors. GLP-1 receptor agonists in older adults were associated with a 15.3% (OR 0.847 (95% CI 0.788 to 0.910)) reduction in MACE events, similar to the 16% benefit seen in younger adults. The use of SGLT-2 inhibitors reduced MACE in older participants by 16.9% (OR 0.831 (95% CI 0.699 to 0.989)), numerically superior to the impact in younger patients (OR 0.936 (95% CI 0.787 to 1.113).Conclusions: GLP-1 receptor agonists and SGLT-2 inhibitors reduced MACE outcomes in older adults who were eligible to participate in clinical trials. Whereas this is reassuring for the biologically robust, it should not be extrapolated to frail older adults without further investigation.
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Recent systematic reviews and meta-analyses found that GLP-1R agonists reduced major adverse cardiovascular events in T2D patients and also had beneficial effects on kidney outcome.
“Recent systematic reviews and meta-analyses found that GLP-1R agonists reduced major adverse cardiovascular events in T2D patients280–282 and also had beneficial effects on kidney outcome.283”
From A review of current trends with type 2 diabetes epidemiology, aetiology, pathogenesis, treatments and future perspectives (2021) · cites this paper as [280]
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- Authors
- Strain, W. D., & Griffiths, J.
- Affiliations
- University of Exeter (GB)
- Royal Devon & Exeter NHS Foundation Trust (GB)
- ORCID
- Strain, William D
- Venue
- British Journal of Diabetes
- Publisher
- ABCD Diabetes Care, Ltd.
- Published
- 2021-05-28
- Volume
- 21
- Issue
- 1
- Pages
- 30-35
- ISSN
- 2397-6233 (ISSN-L)
- 2397-6241
- OpenAlex
- W3138998783
- Cited by
- 16
- References
- 29
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 5 · 2023: 1 · 2022: 2 · 2021: 2
- FWCI
- 0.38
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Locations
- British Journal of Diabetes (publishedVersion)
- British Journal of Diabetes (publishedVersion, cc-by)
- Open Research Exeter (University of Exeter) (submittedVersion)
- Figshare (submittedVersion)
- Funders
- National Institute for Health and Care Research
- NIHR Exeter Clinical Research Facility
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- GLP-1 receptor agonists, SGLT2 inhibitors, major adverse cardiovascular events, older adults, type 2 diabetes, weight loss, frailty, cardiovascular outcome trials
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