TY - JOUR
TI - GLP-1 receptor agonists in diabetes for stroke prevention: a systematic review and meta-analysis
AU - Malhotra, K.
AU - Katsanos, A.H.
AU - Lambadiari, V.
AU - Goyal, N.
AU - Palaiodimou, L.
AU - Kosmidou, M.
AU - Krogias, C.
AU - Alexandrov, A.V.
AU - Tsivgoulis, G.
JO - Egyptian Journal of Neurology, Psychiatry and Neurosurgery
PY - 2020
VL - 267
TODO - 7
SP - 2117-2122
PB - Springer-Verlag
SN - null
TODO - 10.1007/s00415-020-09813-4
TODO - glucagon like peptide 1 receptor agonist;  placebo;  antidiabetic agent;  glucagon like peptide 1 receptor, all cause mortality;  Article;  cardiovascular disease;  cardiovascular mortality;  cardiovascular risk;  cerebrovascular accident;  controlled study;  diabetic patient;  drug efficacy;  drug safety;  heart infarction;  human;  medical history;  meta analysis;  non insulin dependent diabetes mellitus;  priority journal;  randomized controlled trial (topic);  secondary prevention;  systematic review;  cerebrovascular accident;  non insulin dependent diabetes mellitus, Diabetes Mellitus, Type 2;  Glucagon-Like Peptide-1 Receptor;  Humans;  Hypoglycemic Agents;  Stroke
TODO - Background: Randomized controlled clinical trials (RCT) have demonstrated varied efficacy of glucagon-like peptide-1 receptor (GLP-1R) agonists for cardiovascular outcomes. We sought to evaluate the efficacy and safety of GLP-1R agonists among patients with Type 2 diabetes mellitus (DM) for stroke prevention. Methods: We conducted a systematic review and meta-analysis of RCTs reporting the following outcomes among patients with Type 2 DM treated with GLP-1R agonists (vs. placebo): nonfatal or fatal strokes, all-cause or cardiovascular mortality, myocardial infarction (MI) and major adverse cardiovascular events (MACE). The protocol of our systematic review and meta-analysis was registered to the PROSPERO database. We pooled odds ratios (OR) using random-effect models, and assessed the heterogeneity using Cochran Q and I2 statistics. Results: We identified 8 RCTs, comprising 56,251 patients. In comparison to placebo, GLP-1R agonists reduced nonfatal strokes (OR 0.84; 95% CI 0.76–0.94, p = 0.002; I2 = 0%) and all strokes (OR 0.84; 95% CI 0.75–0.93, p = 0.001; I2 = 0%) by 16%. Overall, GLP-1R agonists reduced MACE by 13% (OR 0.87; 95% CI 0.81–0.94, p = 0.0003; I2 = 42%), cardiovascular mortality by 12% (OR 0.88; 95% CI 0.81–0.95; p = 0.002; I2 = 0%) and all-cause mortality by 12% (OR 0.88; 95% CI 0.82–0.95, p = 0.0007; I2 = 15%). Additional analyses demonstrated that GLP-1R agonists reduced the risk of incident MACE (OR 0.86; 95% CI 0.80–0.92; p < 0.0001; I2 = 0%) among patients with prior history of MI or nonfatal strokes. Conclusions: Among patients with type 2 DM, GLP-1R agonists are beneficial for primary stroke, MACE, and cardiovascular mortality prevention. Further RCTs are needed to evaluate their role for secondary stroke prevention. © 2020, Springer-Verlag GmbH Germany, part of Springer Nature.
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