Effects of GLP-1 Receptor Agonists on Cardiovascular Outcomes in Patients with Type 2 Diabetes and Chronic Kidney Disease: A Systematic Review and Meta-Analysis

Authors

Michael S. Kelly, Chapman UniversityFollow
Jelena Lewis, Chapman UniversityFollow
Hindu Rao, Chapman UniversityFollow
Jessica Carter, Chapman University
Ivan Portillo, Chapman UniversityFollow
Richard Beuttler, Chapman UniversityFollow

Document Type

Article

Publication Date

10-22-2022

Abstract

Aim

To evaluate the cardiovascular outcomes of glucagon-like peptide-1 receptor agonists (GLP1-RA) in patients with type 2 diabetes (T2DM) and chronic kidney disease (CKD).

Materials and Methods

We searched PubMed, Ovid MEDLINE, CINAHL, and Web of Science databases for randomized controlled trials reporting event rates for a composite cardiovascular outcome of cardiovascular death, myocardial infarction, and stroke in patients with T2DM and CKD receiving GLP1-RA or placebo. Studies were restricted to those reporting specific event rates for patients with CKD separately from the overall population. We conducted a meta-analysis using a random-effects model. This meta-analysis was registered on PROSPERO (CRD42022320157).

Results

A total of four studies comprising 7130 patients was included in our analysis. Four different GLP1-RA were assessed in a population with CKD defined as estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2. Treatment with GLP1-RA was not associated with a significant reduction in the composite cardiovascular end point of cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke (odds ratio (OR) 0.80; 95% confidence interval (CI), 0.59–1.07; p = 0.13) among patients with T2DM and CKD. Individual components of the composite cardiovascular end point were assessed in two trials and did not show evidence of an effect of GLP1-RA in reducing cardiovascular end points.

Conclusions

Pooled analysis of clinical trials reporting separate cardiovascular events rates in patients with T2DM and CKD did not find GLP1-RA to be associated with a reduction in composite cardiovascular event rates. Select GLP1-RA may offer cardiovascular event reduction in patients with T2DM and CKD, but this does not appear to be a class effect. Use of GLP1-RA with demonstrated cardiovascular benefits should be preferred in patients with CKD and T2DM to further reduce cardiovascular risk.

Comments

This article was originally published in Pharmacotherapy in 2022. https://doi.org/10.1002/phar.2737

Recommended Citation

Kelly M, Lewis J, Rao H, et al. Effects of GLP-1 receptor agonists on cardiovascular outcomes in patients with type 2 diabetes and chronic kidney disease: A systematic review and meta-analysis. Pharmacotherapy. 2022. https://doi.org/10.1002/phar.2737

Copyright

The authors

Creative Commons License

This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 License