Highlights
- •In patients ≥65 years, GLP-1 RAs reduced atherosclerotic oucomes.
- •In patients ≥65 years, SGLT2 inhibitors reduced heart failure and renal outcomes.
- •Some benefits were more pronounced in older patients compared to those <65 years.
- •Results for patients ≥75 years were based on limited data from primary studies.
Abstract
Aims
To assess the cardiovascular effects of glucagon-like peptide-1 receptor agonists
(GLP-1 RAs) and sodium-glucose co-transporter-2 (SGLT2) inhibitors in older people
with type 2 diabetes.
Methods
PubMed, Embase, and Cochrane library were searched up to November 2020 for cardiovascular
outcomes trials with GLP-1 RAs or SGLT2 inhibitors that reported results for older
patients with type 2 diabetes. Random-effects meta-analyses were conducted for different
age subgroup categories.
Results
A total of 11 studies (93,502 patients) were included. Consistent with their effect
in the overall population, in patients ≥65 years, GLP-1 RAs reduced major adverse
cardiovascular events (MACE) (hazard ratio [HR], 0.86; 95% confidence interval [CI],
0.80–0.92), cardiovascular death, stroke, and myocardial infarction. In the same age
subgroup, SGLT2 inhibitors reduced MACE (HR, 0.90; 95% CI, 0.83–0.98) but had a neutral
effect on its components. They also reduced heart failure hospitalization (HR, 0.62;
95% CI, 0.51–0.76), an effect that was not evident in patients <65 years, and the
composite renal endpoint (HR, 0.57; 95% CI, 0.43–0.77). Meta-analyses for patients
≥75 years yielded similar results.
Conclusions
In older adults with diabetes, GLP-1 RAs reduced MACE and its components. SGLT2 inhibitors
reduced MACE, and heart failure and renal outcomes.
Keywords
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Article info
Publication history
Published online: March 08, 2021
Accepted:
February 23,
2021
Received in revised form:
January 31,
2021
Received:
December 14,
2020
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
