Relación entre el uso de inhibidores SGLT2 y agonistas GLP-1 con desenlaces cardiovasculares en pacientes con Diabetes Mellitus tipo 2: Una Revisión sistemática y Metaanálisis

Abstract

Antecedentes: Recientes ensayos en Diabetes Mellitus tipo 2 enfocan en efectos cardiovasculares de inhibidores del SGLT-2 y de los agonistas de la GLP-1. Se evaluará sistemáticamente los efectos cardiovasculares y adversos de SGLT-2i y agonistas GLP-1. Métodos: Se condujo una revisión sistemática de ECAs en adultos con DM tipo 2 que evaluó los efectos de los SGLT-2i y los GLP-1 en desenlaces cardiovasculares y eventos adversos. Los desenlaces primarios fueron mortalidad global, mortalidad cardiovascular, infarto de miocardio, desorden cerebro-vascular, y desenlace compuesto (MACE: mortalidad cardiovascular, IMA, angina inestable). Además, se estudiaron cuatro desenlaces cardiovasculares y efectos adversos como varables secundarias. Se realizo una búsqueda en 5 buscadores hasta agosto de 2019. Se realizó meta-análisis de efectos aleatorizados. Los efectos fueron expresados en riesgo relativo con un intervalo de confianza de 95%. Los análisis fueron estratificados por familias. Resultados: Se evaluó 37 artículos. Los inhibidores SGLT-2 se asociaron a menor riesgo de mortalidad global(RR 0.85, 95%CI 0.84-0.99), mortalidad cardiovascular(RR 0.43, 95%CI 0.39-0.48), MACE(RR 0.90 IC 95% 0.85-0.96), e IMA(RR 0.88, 95% CI 0.80-0.97. Los agonistas de GLP-1 fueron asociados a menor riesgo de mortalidad cardiovascular (RR 0.90 , IC 95% 0.82-0.98), desorden cerebrovascular (RR 0.84 95% CI 0.74-0.94) e infarto agudo de miocardio (RR 0.83, IC 95% 0.70-0.97). Conclusiones: Añadir medicamentos de cualquier familia al tratamiento actual de pacientes con diabetes tipo 2 puede mejorar los resultados CV con menor incidencia de eventos adversos.

Background: Recent randomized controlled trials (RCTs) in type 2 diabetes mellitus (T2DM) have focused on cardiovascular (CV) effects of sodium-glucose cotransporter-2 (SGLT-2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP-1). We systematically evaluated the CV effects of SGLT-2 inhibitors and GLP-1 agonists. Methods: We performed a systematic review of RCTs in adults with T2DM evaluating the effects of SGLT-2 inhibitors and GLP-1 on CV outcomes and drug-related harmful events (HEs). Primary outcomes included overall mortality, CV mortality (CVM), myocardial infarction (MI), stroke, and a composite outcome (i.e. CVM, MI, or stroke). Secondary outcomes were HEs. A literature search was conducted in five engines until August 2019. Traditional random effects meta-analyses were performed. The effects were expressed as risk ratios (RR) with 95% confidence intervals (95% CI). Analyses were stratified by drug family. Results: We evaluated 37 studies. SGLT-2 inhibitors (SGLT-2i) were associated with lower risk for overall mortality (RR 0.85, 95%CI 0.84-0.99), CV mortality (RR 0.43, 95%CI 0.39-0.48), composite outcome (RR 0.90 IC 95% 0.85-0.96) and MI RR 0.88, 95% CI 0.80-0.97); also, there was lower risk of auricular fibrillation or decompensated heart failure. The GLP-1 agonists were associated with lower risk for cardiovascular mortality (RR 0.90 , IC 95% 0.82-0.98), stroke (RR 0.84 95% CI 0.74-0.94) and MI (RR 0.83, IC 95% 0.70-0.97). In addition, SGLT-2i were associated with an increased risk for genital, while GLP-1 agonists were associated with an increased risk for diarrhea, nausea, vomiting, upper respiratory tract infections and high lipase blood concentration Conclusions: SGLT-2 inhibitors significantly reduced overall mortality, myocardial infarction, and composite outcomes. GLP-1 agonists significantly reduced cardiovascular mortality. Adding drugs of either family to the current treatment in type 2 diabetes patients may improve cardiovascular outcomes with lower incidence of HEs.