Abstract：
BACKGROUND: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter 2 inhibitors (SGLT2is), while developed as antihyperglycaemic medications for the treatment of type 2 diabetes, have proven to reduce major cardiovascular adverse events (MACEs) and hospitalization for heart failure (especially for SGLT2is) in dedicated cardiovascular outcome trials. The contribution of the glucose-lowering effect in the cardiovascular protection is uncertain and may differ between the two drug classes.
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.
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.
摘要：
背景：-：胰高血糖素样肽-1受体激动剂（GLP-1RAs）和钠-葡萄糖协同转运蛋白2抑制剂（SGLT2is），作为治疗2型糖尿病的降血糖药物，在专门的心血管结局试验中，已证明可以减少主要心血管不良事件（MACEs）和心力衰竭（尤其是SGLT2is）的住院治疗。降糖作用在心血管保护中的作用尚不确定，并且在两种药物之间可能有所不同。
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。
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。
