背景:塞马鲁肽,胰高血糖素样肽-1受体激动剂,据报道有心脏益处,但其对预防心房颤动(AF)的作用仍无定论。本研究旨在探讨司马鲁肽能否预防2型糖尿病(T2DM)患者房颤的发生,肥胖,或超重。
方法:我们搜索了MEDLINE,EMBASE,CochraneCENTRAL数据库,和clinicaltrials.gov从成立到2023年12月29日。司马鲁肽治疗T2DM的随机对照试验,肥胖,或超重也包括在内。主要结果是房颤发生。计算总体人群和亚组的相对风险(RR)和95%置信区间(CI)。
结果:纳入21项包含25957名患者的试验。在总体汇总分析中,与对照药物相比,司马鲁肽降低了房颤发生率(RR0.70,95%CI0.52-0.95)。该结果在使用其他抗高血糖药物作为对照的试验中一致(RR0.43,95%CI0.21-0.89),但在安慰剂对照试验中没有(RR0.77,95%CI0.56-1.07)。结果对T2DM患者有利(RR0.71,95%CI0.52-0.97),但不适用于超重或肥胖患者(RR0.56,95%CI0.18-1.73)。结果因semaglutide的类型而异,口服司马鲁肽的RR为0.49(95%CI0.25-0.97),皮下司马鲁肽的RR为0.77(95%CI0.55-1.07)。
结论:塞马鲁肽在总体分析中与房颤发生风险降低相关。在使用其他降糖药物作为对照的亚组中观察到良好的结果,在T2DM患者中,和口服司马鲁肽。
BACKGROUND: Semaglutide, a glucagon-like peptide-1 receptor agonist, is reported to have cardiac benefits, but its effects on preventing atrial fibrillation (AF) remain inconclusive. This study aimed to investigate whether
semaglutide can prevent AF occurrence in patients with type 2 diabetes mellitus (T2DM), obesity, or overweight.
METHODS: We searched MEDLINE, EMBASE, the Cochrane CENTRAL database, and clinicaltrials.gov from inception to December 29, 2023. Randomized controlled trials of
semaglutide in patients with T2DM, obesity, or overweight were included. The primary outcome was AF occurrence. Relative risks (RRs) with 95 % confidence intervals (CIs) were calculated for the overall population and subgroups.
RESULTS: Twenty-one trials comprising 25957 patients were included. In the overall pooled analysis, semaglutide decreased AF occurrence compared to control drugs (RR 0.70, 95 % CI 0.52-0.95). This result was consistent in trials using other antihyperglycemic medications as controls (RR 0.43, 95 % CI 0.21-0.89), but not in placebo-controlled trials (RR 0.77, 95 % CI 0.56-1.07). The outcome was favorable for patients with T2DM (RR 0.71, 95 % CI 0.52-0.97), but not for patients with overweight or obesity (RR 0.56, 95 % CI 0.18-1.73). Results varied by type of
semaglutide, with oral
semaglutide showing an RR of 0.49 (95 % CI 0.25-0.97) and subcutaneous
semaglutide showing an RR of 0.77 (95 % CI 0.55-1.07).
CONCLUSIONS: Semaglutide was associated with a reduced risk of AF occurrence in the overall analysis. Favorable outcomes were observed in subsets using other antihyperglycemic medications as controls, in patients with T2DM, and with oral semaglutide.