METHODS: This narrative review compares the relative effects of glycated hemoglobin (HbA1c) reduction on the cardiovascular protection provided by GLP-1RAs and SGLT2is in placebo-controlled cardiovascular outcome trials by using the results of either post-hoc mediation analyses or meta-regression studies.
RESULTS: Both mediation and meta-regression analyses suggest that the lower cardiovascular risk with GLP-1RAs partially but substantially tracks with their glucose-lowering effect, especially when considering the reduction in nonfatal strokes. In contrast, similar analyses fail to demonstrate any significant contribution of the glucose-lowering effect with SGLT2is, not only on MACEs but also on heart failure issues.
CONCLUSIONS: The contribution of improved glucose control in cardiovascular protection is limited, but is much greater for GLP-1RAs than for SGLT2is. Of note, such mediation or meta-regression analyses are exploratory and can only be viewed as hypothesis generating.
方法:-:本叙述性综述通过使用事后调解分析或荟萃回归研究的结果,比较了在安慰剂对照心血管结局试验中,糖化血红蛋白(HbA1c)降低对GLP-1RAs和SGLT2is提供的心血管保护作用的相对影响。
结果:-:中介和荟萃回归分析均表明,GLP-1RAs的降低心血管风险部分但基本上与其降糖作用有关,尤其是在考虑减少非致命性中风时。相比之下,类似的分析未能证明SGLT2is的降糖作用有任何显著贡献,不仅在MACE上,而且在心力衰竭问题上。
结论:-:改善血糖控制在心血管保护中的作用有限,但GLP-1RA比SGLT2is大得多。值得注意的是,这种中介或荟萃回归分析是探索性的,只能被视为假设的产生。