Background: Changes in vascular function are closely associated with the development of cardiovascular disease (CVD). Pulse wave velocity (PWV) is a potential indicator of vascular dysfunction; it allows noninvasive assessment of arterial stiffness. Currently, evidence for the effects of different classes of antidiabetic drugs on arterial stiffness remains limited. In this study, a network meta-analysis (NMA) was performed to explore the associations between changes in arterial stiffness and first-line antidiabetic drugs by evaluating PWV in patients with different metabolic abnormalities.
Methods: We systematically searched several electronic databases for randomized controlled trials (RCTs) published from inception until 25 August 2022, without language restrictions. The primary outcome was the change in PWV (ΔPWV) in all included studies; subgroup analysis was performed for patients with abnormal glucose metabolism, including prediabetes and diabetes mellitus. NMA was performed to calculate the mean differences (MDs) with 95% confidence intervals (CIs) as effect sizes to evaluate the ΔPWV.
Results: Among the 2257 candidate articles identified in the initial search, 18 RCTs were eventually included in the analysis. In all studies, two classes of new antidiabetic drugs, glucagon-like peptide-1 receptor (GLP-1R) agonists and sSodium-glucose co-transporter 2 (SGLT-2) inhibitors, improved arterial stiffness by decreasing PWV compared with placebo (MD = -1.11, 95% CI: -1.94 to 0.28) and (MD = -0.76, 95% CI: -1.45 to -0.08). A conventional antidiabetic drug, metformin, also showed similar efficacy compared with placebo (MD = -0.73, 95% CI: -1.33 to -0.12). Finally, in subgroup studies of patients with abnormal glucose metabolism diseases, GLP-1R agonists (MD = -1.06, 95% CI: -2.05 to -0.10) significantly decreased PWV compared with placebo.
Conclusion: Three classes of antidiabetic drugs-GLP-1R agonists, SGLT-2 inhibitors, and metformin-have the potential to improve arterial stiffness. Among the six classes of antidiabetic drugs analyzed, GLP-1R agonists constitute the only class of drugs that improves arterial stiffness in patients with abnormal glucose metabolism diseases.
背景:血管功能的改变与心血管疾病(CVD)的发展密切相关。脉搏波传导速度(PWV)是血管功能紊乱的潜在指标, 可无创评估动脉硬化程度。目前, 不同类型的降糖药对动脉硬化影响的证据仍然有限。本研究通过网络meta分析(NMA)评估不同代谢异常患者的PWV, 探讨动脉硬化变化与一线降糖药物的关系。 方法:系统检索多个电子数据库, 纳入从建库至2022年8月25日发表的随机对照试验(RCTs), 无语言限制。主要结局指标为所有纳入研究中PWV的变化(ΔPWV);对糖代谢异常患者进行亚组分析, 包括糖尿病前期和糖尿病。采用NMA计算均数差(MDs)及其95%可信区间(CIs)作为效应量评价ΔPWV。 结果:共检索到2257篇文献, 最终纳入18项RCTs进行分析。在所有研究中, 与安慰剂相比, 两类新型降糖药物, GLP-1受体激动剂和SGLT-2抑制剂通过降低PWV改善动脉硬化(MD =−1.11,95% CI:−1.94 ~ 0.28)和(MD =−0.76,95% CI:−1.45 ~−0.08), 以及传统降糖药二甲双胍也显示出相似的疗效(MD = - 0.73, 95% CI: - 1.33 ~ - 0.12)。最后, 在糖代谢异常疾病患者的亚组研究中, 与安慰剂相比, GLP-1受体激动剂(MD =−1.06,95% CI:−2.05 ~−0.10)显著降低了PWV。 结论:三类降糖药物, 即GLP-1受体激动剂, SGLT-2抑制剂和二甲双胍, 具有改善动脉硬化的潜力。在分析的六类降糖药物中, GLP-1受体激动剂是唯一一类可以改善异常糖代谢患者动脉硬化的药物。.
Keywords: antidiabetic drugs; arterial stiffness; cardiovascular outcome; pulse wave velocity; vascular function; 动脉硬化; 心血管结局; 脉搏波传导速度; 血管功能; 降糖药物.
© 2023 The Authors. Journal of Diabetes published by Ruijin Hospital, Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.