Do SGLT2 inhibitors and GLP-1 receptor agonists modulate differently the risk of stroke ? Discordance between randomised controlled trials and observational studies.
GLP-1 receptor agonist; Randomised control trial; Real-world evidence; SGLT2 inhibitor; Stroke; Type 2 diabetes
Abstract :
[en] Stroke represents a major burden in patients with type 2 diabetes, yet this cerebrovascular complication has been less carefully investigated than the risk of cardiovascular mortality, heart failure and renal disease. Some data suggested that glucagon peptide-1 receptor agonists (GLP-1RAs) exert a better protection against stroke than sodium-glucose cotransporter 2 inhibitors (SGLT2is). However, this conclusion was derived from indirect comparisons in absence of any head-to-head randomised controlled trial (RCT). The present comprehensive review compares the effects of SGLT2is versus GLP-1RAs on nonfatal and fatal/nonfatal strokes in network meta-analyses of RCTs (mostly cardiovascular outcome trials) versus placebo, on the one hand, and in real-life observational cohort studies, on the other hand. Whereas network meta-analyses of placebo-controlled RCTs confirm a slight but significant (in 11 out of 13 meta-analyses) higher incidence of stroke in patients treated with SGLT2is compared with those treated with GLP-1RAs, a large majority of retrospective observational cohort studies (19 out of 21) failed to find any significant difference in the risk of stroke between the two pharmacological classes. Available, yet limited, findings suggest that SGLT2is may be more efficacious against haemorrhagic than ischaemic strokes, in patients at risk for atrial fibrillation and in patients with chronic kidney disease.
Disciplines :
Pharmacy, pharmacology & toxicology Cardiovascular & respiratory systems
Author, co-author :
Scheen, André ; Centre Hospitalier Universitaire de Liège - CHU > > Service de diabétologie, nutrition, maladies métaboliques
Language :
English
Title :
Do SGLT2 inhibitors and GLP-1 receptor agonists modulate differently the risk of stroke ? Discordance between randomised controlled trials and observational studies.
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Bibliography
Mosenzon, O., Cheng, A.Y., Rabinstein, A.A., Sacco, S., Diabetes and stroke: what are the connections?. J Stroke 25 (2023), 26–38.
Kernan, W.N., Forman, R., Inzucchi, S.E., Caring for patients with diabetes in stroke neurology. Stroke 54 (2023), 894–904.
Bell, D.S.H., Goncalves, E., Stroke in the patient with diabetes (part 1) - Epidemiology, etiology, therapy and prognosis. Diabetes Res Clin Pract, 164, 2020, 108193.
Lau, L.H., Lew, J., Borschmann, K., Thijs, V., Ekinci, E.I., Prevalence of diabetes and its effects on stroke outcomes: a meta-analysis and literature review. J Diabetes Investig 10 (2019), 780–792.
Balasubramanian, P., Kernan, W.N., Sheth, K.N., Ofstad, A.P., Rosenstock, J., Wanner, C., et al. Baseline cardiovascular risk factor control in patients with type 2 diabetes and coronary disease versus troke: secondary analysis of cardiovascular outcome trials. Stroke 54 (2023), 2013–2021.
Echouffo-Tcheugui, J.B., Turchin, A., Rosenson, R.S., Fonarow, G.C., Goyal, A., de Lemos, J.A., et al. Quality of care among patients with diabetes and cerebrovascular disease. insights from the Diabetes Collaborative Registry. Am J Med 135 (2022), 1336–1341.
Kuo, S., Yang, C.T., Herman, W.H., Lisabeth, L.D., Ye, W., National trends in the achievement of recommended strategies for stroke prevention in U.S. adults with type 2 diabetes, 2001-2018. Diabetes Care 45 (2022), 2003–2011.
Bonnet, F., Scheen, A.J., Impact of glucose-lowering therapies on risk of stroke in type 2 diabetes. Diabetes Metab 43 (2017), 299–313.
Ahn, C.H., Lim, S., Effects of thiazolidinedione and new antidiabetic agents on stroke. J Stroke 21 (2019), 139–150.
Bell, D.S.H., Goncalves, E., Stroke in the patient with diabetes (Part 2) - Prevention and the effects of glucose lowering therapies. Diabetes Res Clin Pract, 164, 2020, 108199.
Lim, S., Oh, T.J., Dawson, J., Sattar, N., Diabetes drugs and stroke risk: intensive versus conventional glucose-lowering strategies, and implications of recent cardiovascular outcome trials. Diabetes Obes Metab 22 (2020), 6–15.
Du, L., Zhang, Y., Wang, P., Li, Z., Zhao, Y., Substantially different findings concerning the cardiovascular and cerebrovascular effectiveness of GLP1RAs vs. SGLT2is. Front Cardiovasc Med, 9, 2022, 1034095.
Yanai, H., Adachi, H., Hakoshima, M., Katsuyama, H., Glucagon-like peptide 1 receptor agonists versus sodium-glucose cotransporter 2 inhibitors for atherosclerotic cardiovascular disease in patients with type 2 diabetes. Cardiol Res 14 (2023), 12–21.
Brown, E., Heerspink, H.J.L., Cuthbertson, D.J., Wilding, J.P.H., SGLT2 inhibitors and GLP-1 receptor agonists: established and emerging indications. Lancet 398 (2021), 262–276.
Dardano, A., Miccoli, R., Bianchi, C., Daniele, G., Del Prato, S, Invited review. Series: implications of the recent CVOTs in type 2 diabetes: which patients for GLP-1RA or SGLT-2 inhibitor?. Diabetes Res Clin Pract, 162, 2020, 108112.
Davies, M.J., Aroda, V.R., Collins, B.S., Gabbay, R.A., Green, J., Maruthur, N.M., et al. Management of hyperglycaemia in type 2 diabetes, 2022. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia 65 (2022), 1925–1966.
Scheen, A.J., Cardiovascular outcome studies in type 2 diabetes : comparison between SGLT2 inhibitors and GLP-1 receptor agonists. Diabetes Res Clin Pract 143 (2018), 88–100.
Karagiannis, T., Tsapas, A., Athanasiadou, E., Avgerinos, I., Liakos, A., Matthews, D.R., et al. GLP-1 receptor agonists and SGLT2 inhibitors for older people with type 2 diabetes: a systematic review and meta-analysis. Diabetes Res Clin Pract, 174, 2021, 108737.
Zelniker, T.A., Wiviott, S.D., Raz, I., Im, K., Goodrich, E.L., Furtado, R.H.M., et al. Comparison of the effects of glucagon-like peptide receptor agonists and sodium-glucose cotransporter 2 inhibitors for prevention of major adverse cardiovascular and renal outcomes in type 2 diabetes mellitus. Circulation 139 (2019), 2022–2031.
Rodriguez-Valadez, J.M., Tahsin, M., Fleischmann, K.E., Masharani, U., Yeboah, J., Park, M., et al. Cardiovascular and renal benefits of novel diabetes drugs by baseline cardiovascular risk: a systematic review, meta-analysis, and meta-regression. Diabetes Care 46 (2023), 1300–1310.
Al Hamed, F.A., Elewa, H., Potential therapeutic effects of sodium glucose-linked cotransporter 2 inhibitors in stroke. Clin Ther, 42, 2020 e242-e9.
Mascolo, A., Scavone, C., Scisciola, L., Chiodini, P., Capuano, A., Paolisso, G., SGLT-2 inhibitors reduce the risk of cerebrovascular/cardiovascular outcomes and mortality: a systematic review and meta-analysis of retrospective cohort studies. Pharmacol Res, 172, 2021, 105836.
Seo, B., Su, J., Song, Y., Exploring heterogeneities of cardiovascular efficacy and effectiveness of SGLT2 inhibitors in patients with type 2 diabetes: an umbrella review of evidence from randomized clinical trials versus real-world observational studies. Eur J Clin Pharmacol 78 (2022), 1205–1216.
Zhang, C., Zhang, X., Wang, P., Zhu, Q., Mei, Y., Zhang, Z., et al. Effect of SGLT2 inhibitors on risk of stroke in diabetes: a meta-analysis. Cerebrovasc Dis 51 (2022), 585–593.
Caruso, I., Cignarelli, A., Sorice, G.P., Natalicchio, A., Perrini, S., Laviola, L., et al. Cardiovascular and renal effectiveness of GLP-1 receptor agonists vs. other glucose-lowering drugs in type 2 diabetes: a systematic review and meta-analysis of real-world studies. Metabolites, 12, 2022, 183.
Qiu, M., Wei, X.B., Wei, W., SGLT2is vs. GLP1RAs reduce cardiovascular and all-cause mortality. Front Cardiovasc Med, 8, 2021, 791311.
Du, L., Qin, J., Wang, D., Zhao, Y., Xu, N., Wu, C., Commentary: SGLT2is vs. GLP1RAs reduce cardiovascular and all-cause mortality. Front Cardiovasc Med, 9, 2022, 987025.
Du, L., Li, Z., Lan, P., Huang, H., Cheng, W., Effectiveness of SGLT2is vs. GLP-1RAs on cardiovascular and cerebrovascular outcomes in T2D patients according to CVD status. Front Cardiovasc Med, 9, 2022, 1011535.
Li, S., Vandvik, P.O., Lytvyn, L., Guyatt, G.H., Palmer, S.C., Rodriguez-Gutierrez, R., et al. SGLT-2 inhibitors or GLP-1 receptor agonists for adults with type 2 diabetes: a clinical practice guideline. BMJ, 373, 2021, n1091.
Fei, Y., Tsoi, M.F., Cheung, B.M.Y., Cardiovascular outcomes in trials of new antidiabetic drug classes: a network meta-analysis. Cardiovasc Diabetol, 18, 2019, 112.
Hussein, H., Zaccardi, F., Khunti, K., Seidu, S., Davies, M.J., Gray, L.J., Cardiovascular efficacy and safety of sodium-glucose co-transporter-2 inhibitors and glucagon-like peptide-1 receptor agonists: a systematic review and network meta-analysis. Diabet Med 36 (2019), 444–452.
Tsapas, A., Avgerinos, I., Karagiannis, T., Malandris, K., Manolopoulos, A., Andreadis, P., et al. Comparative effectiveness of glucose-lowering drugs for type 2 diabetes: a systematic review and network meta-analysis. Ann Intern Med 173 (2020), 278–286.
Palmer, S.C., Tendal, B., Mustafa, R.A., Vandvik, P.O., Li, S., Hao, Q., et al. Sodium-glucose cotransporter protein-2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists for type 2 diabetes: systematic review and network meta-analysis of randomised controlled trials. BMJ, 372, 2021, m4573.
Lin, D.S., Lee, J.K., Hung, C.S., Chen, W.J., The efficacy and safety of novel classes of glucose-lowering drugs for cardiovascular outcomes: a network meta-analysis of randomised clinical trials. Diabetologia 64 (2021), 2676–2686.
Kanie, T., Mizuno, A., Takaoka, Y., Suzuki, T., Yoneoka, D., Nishikawa, Y., et al. Dipeptidyl peptidase-4 inhibitors, glucagon-like peptide 1 receptor agonists and sodium-glucose co-transporter-2 inhibitors for people with cardiovascular disease: a network meta-analysis. Cochrane Database Syst Rev, 10, 2021, CD013650.
Giugliano, D., Longo, M., Signoriello, S., Maiorino, M.I., Solerte, B., Chiodini, P., et al. The effect of DPP-4 inhibitors, GLP-1 receptor agonists and SGLT-2 inhibitors on cardiorenal outcomes: a network meta-analysis of 23 CVOTs. Cardiovasc Diabetol, 21, 2022, 42.
Sim, R., Chong, C.W., Loganadan, N.K., Fong, A.Y.Y., Navaravong, L., Hussein, Z., et al. Comparative effectiveness of cardiovascular, renal and safety outcomes of second-line antidiabetic drugs use in people with type 2 diabetes: a systematic review and network meta-analysis of randomised controlled trials. Diabet Med, 2021, e14780.
Ali, M.U., Mancini, G.B.J., Fitzpatrick-Lewis, D., Lewis, R., Jovkovic, M., Zieroth, S., et al. The effectiveness of sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor agonists on cardiorenal outcomes: systematic review and meta-analysis. Can J Cardiol 38 (2022), 1201–1210.
Shi, Q., Nong, K., Vandvik, P.O., Guyatt, G.H., Schnell, O., Ryden, L., et al. Benefits and harms of drug treatment for type 2 diabetes: systematic review and network meta-analysis of randomised controlled trials. BMJ, 381, 2023, e074068.
Sabouret, P., Bocchino, P.P., Angelini, F., D'Ascenzo, F., Galati, G., Fysekidis, M., et al. Comparing benefits from sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists in randomized clinical trials: a network meta-analysis. Minerva Cardiol Angiol 71 (2023), 199–207.
Kilickap, M., Kozluca, V., Tan, T.S., Akbulut Koyuncu, I.M, GLP-1 receptor agonists and SGLT-2 inhibitors in patients with versus without cardiovascular disease: a systematic review, meta-analysis, and trial sequential analysis. Angiology, 2023, 33197231183229.
Nguyen, B.N., Nguyen, L., Mital, S., Bugden, S., Nguyen, H.V., Comparative efficacy of sodium-glucose co-transporter-2 inhibitors, glucagon-like peptide-1 receptor agonists and non-steroidal mineralocorticoid receptor antagonists in chronic kidney disease and type 2 diabetes: a systematic review and network meta-analysis. Diabetes Obes Metab 25 (2023), 1614–1623.
O'Brien, M.J., Karam, S.L., Wallia, A., Kang, R.H., Cooper, A.J., Lancki, N., et al. Association of second-line antidiabetic medications with cardiovascular events among insured adults with type 2 diabetes. JAMA Netw Open, 1, 2018, e186125.
Patorno, E., Goldfine, A.B., Schneeweiss, S., Everett, B.M., Glynn, R.J., Liu, J., et al. Cardiovascular outcomes associated with canagliflozin versus other non-gliflozin antidiabetic drugs: population based cohort study. BMJ, 360, 2018, k119.
Longato, E., Di Camillo, B., Sparacino, G., Gubian, L., Avogaro, A., Fadini, G.P., Cardiovascular outcomes of type 2 diabetic patients treated with SGLT-2 inhibitors versus GLP-1 receptor agonists in real-life. BMJ Open Diabetes Res Care, 8, 2020, e001451.
Pineda, E.D., Liao, I.C., Godley, P.J., Michel, J.B., Rascati, K.L., Cardiovascular outcomes among patients with type 2 diabetes newly initiated on sodium-glucose cotransporter-2 inhibitors, glucagon-like peptide-1 receptor agonists, and other antidiabetic medications. J Manag Care Spec Pharm 26 (2020), 610–618.
DeRemer, C.E., Vouri, S.M., Guo, J., Donahoo, W.T., Winterstein, A.G., Shao, H., Comparing cardiovascular benefits between GLP-1 receptor agonists and SGLT2 inhibitors as an add-on to metformin among patients with type 2 diabetes: a retrospective cohort study. J Diabetes Complicat, 35, 2021, 107972.
Lugner, M., Sattar, N., Miftaraj, M., Ekelund, J., Franzen, S., Svensson, A.M., et al. Cardiorenal and other diabetes related outcomes with SGLT-2 inhibitors compared to GLP-1 receptor agonists in type 2 diabetes: nationwide observational study. Cardiovasc Diabetol, 20, 2021, 67.
Patorno, E., Htoo, P.T., Glynn, R.J., Schneeweiss, S., Wexler, D.J., Pawar, A., et al. Sodium-glucose cotransporter-2 inhibitors versus glucagon-like peptide-1 receptor agonists and the risk for cardiovascular outcomes in routine care patients with diabetes across categories of cardiovascular disease. Ann Intern Med 174 (2021), 1528–1541.
Patorno, E., Pawar, A., Bessette, L.G., Kim, D.H., Dave, C., Glynn, R.J., et al. Comparative effectiveness and safety of sodium-glucose cotransporter 2 inhibitors versus glucagon-like peptide 1 receptor agonists in older adults. Diabetes Care 44 (2021), 826–835.
Hsiao, F.C., Lin, C.P., Tung, Y.C., Wu, C.T., Chu, P.H., Major adverse limb events in type 2 diabetes patients receiving glucagon-like peptide-1 receptor agonists versus sodium-glucose cotransporter 2 inhibitors: a retrospective multi-institutional study. Diabetes Res Clin Pract, 180, 2021, 109076.
Poonawalla, I.B., Bowe, A.T., Tindal, M.C., Meah, Y.A., Schwab, P., A real-world comparison of cardiovascular, medical and costs outcomes in new users of SGLT2 inhibitors versus GLP-1 agonists. Diabetes Res Clin Pract, 175, 2021, 108800.
Ueda, P., Wintzell, V., Dahlqwist, E., Eliasson, B., Svensson, A.M., Franzen, S., et al. The comparative cardiovascular and renal effectiveness of sodium-glucose co-transporter-2 inhibitors and glucagon-like peptide-1 receptor agonists: a Scandinavian cohort study. Diabetes Obes Metab 24 (2022), 473–485.
Norgaard, C.H., Starkopf, L., Gerds, T.A., Vestergaard, P., Bonde, A.N., Fosbol, E., et al. Cardiovascular outcomes with GLP-1 receptor agonists vs. SGLT-2 inhibitors in patients with type 2 diabetes. Eur Heart J Cardiovasc Pharmacother 8 (2022), 549–556.
Baviera, M., Foresta, A., Colacioppo, P., Macaluso, G., Roncaglioni, M.C., Tettamanti, M., et al. Effectiveness and safety of GLP-1 receptor agonists versus SGLT-2 inhibitors in type 2 diabetes: an Italian cohort study. Cardiovasc Diabetol, 21, 2022, 162.
Htoo, P.T., Tesfaye, H., Schneeweiss, S., Wexler, D.J., Everett, B.M., Glynn, R.J., et al. Comparative effectiveness of empagliflozin vs liraglutide or sitagliptin in older adults with diverse patient characteristics. JAMA Netw Open, 5, 2022, e2237606.
Dong, Y.H., Chang, C.H., Lin, J.W., Yang, W.S., Wu, L.C., Toh, S., Comparative cardiovascular effectiveness of glucagon-like peptide-1 receptor agonists versus sodium-glucose cotransporter-2 inhibitors in patients with type 2 diabetes: a population-based cohort study. Diabetes Obes Metab 24 (2022), 1623–1637.
Lin, D.S., Yu, A.L., Lo, H.Y., Lien, C.W., Lee, J.K., Chen, W.J., Major adverse cardiovascular and limb events in people with diabetes treated with GLP-1 receptor agonists vs SGLT2 inhibitors. Diabetologia 65 (2022), 2032–2043.
Fu, E.L., Clase, C.M., Janse, R.J., Lindholm, B., Dekker, F.W., Jardine, M.J., et al. Comparative effectiveness of SGLT2i versus GLP1-RA on cardiovascular outcomes in routine clinical practice. Int J Cardiol 352 (2022), 172–179.
Lyu, B., Grams, M.E., Chang, A., Inker, L.A., Coresh, J., Shin, J.I., Sodium-glucose cotransporter 2 inhibitors, glucagon-like peptide-1 receptor agonists, and dipeptidyl peptidase-4 inhibitors, and risk of hospitalization. Am J Cardiol 165 (2022), 124–130.
Wright, A.K., Carr, M.J., Kontopantelis, E., Leelarathna, L., Thabit, H., Emsley, R., et al. Primary prevention of cardiovascular and heart failure events with SGLT2 inhibitors, GLP-1 receptor agonists, and their combination in type 2 diabetes. Diabetes Care 45 (2022), 909–918.
Rathmann, W., Kostev, K., Association of glucose-lowering drugs with incident stroke and transient ischaemic attacks in primary care patients with type 2 diabetes: disease analyzer database. Acta Diabetol 59 (2022), 1443–1451.
Lui, D.T.W., Tang, E.H.M., Wu, T., Au, I.C.H., Lee, C.H., Woo, Y.C., et al. Risks of stroke, its subtypes and atrial fibrillation associated with glucagon-like peptide 1 receptor agonists versus sodium-glucose cotransporter 2 inhibitors: a real-world population-based cohort study in Hong Kong. Cardiovasc Diabetol, 22, 2023, 40.
Xie, Y., Bowe, B., Xian, H., Loux, T., McGill, J.B., Al-Aly, Z, Comparative effectiveness of SGLT2 inhibitors, GLP-1 receptor agonists, DPP-4 inhibitors, and sulfonylureas on risk of major adverse cardiovascular events: emulation of a randomised target trial using electronic health records. Lancet Diabetol Endocrinol 11 (2023), 644–656, 10.1016/S2213-8587(23)00171-7.
Zinman, B., Wanner, C., Lachin, J.M., Fitchett, D., Bluhmki, E., Hantel, S., et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med 373 (2015), 2117–2128.
Zinman, B., Inzucchi, S.E., Lachin, J.M., Wanner, C., Fitchett, D., Kohler, S., et al. Empagliflozin and cerebrovascular events in patients with type 2 diabetes mellitus at high cardiovascular risk. Stroke 48 (2017), 1218–1225.
Imprialos, K.P., Boutari, C., Stavropoulos, K., Doumas, M., Karagiannis, A.I., Stroke paradox with SGLT-2 inhibitors: a play of chance or a viscosity-mediated reality?. J Neurol Neurosurg Psychiatry 88 (2017), 249–253.
Guo, M., Ding, J., Li, J., Wang, J., Zhang, T., Liu, C., et al. SGLT2 inhibitors and risk of stroke in patients with type 2 diabetes: a systematic review and meta-analysis. Diabetes Obes Metab 20 (2018), 1977–1982.
Malhotra, K., Katsanos, A.H., Lambadiari, V., Goyal, N., Palaiodimou, L., Kosmidou, M., et al. GLP-1 receptor agonists in diabetes for stroke prevention: a systematic review and meta-analysis. J Neurol 267 (2020), 2117–2122.
Banerjee, M., Pal, R., Mukhopadhyay, S., Nair, K., GLP-1 receptor agonists and risk of adverse cerebrovascular outcomes in type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials. J Clin Endocrinol Metab 108 (2023), 1806–1812.
Li, J., Ji, C., Zhang, W., Lan, L., Ge, W., Effect of new glucose-lowering drugs on stroke in patients with type 2 diabetes: a systematic review and meta-analysis. J Diabetes Complicat, 37, 2023, 108362.
Mukhopadhyay, P., Sanyal, D., Chatterjee, P., Pandit, K., Ghosh, S., SGLT2 inhibitors: effect on myocardial infarction and stroke in type 2 diabetes. J Clin Endocrinol Metab 108 (2023), 2134–2140.
Fatima, K., Suri, A., Rija, A., Kalim, S., Javaid, S., Arif, Z., et al. The effect of sodium-glucose co-transporter 2 inhibitors on stroke and atrial fibrillation: a systematic review and meta-analysis. Curr Probl Cardiol, 48, 2023, 101582.
Goldenberg, R.M., Cheng, A.Y.Y., Fitzpatrick, T., Gilbert, J.D., Verma, S., Hopyan, J.J., Benefits of GLP-1 (glucagon-like peptide 1) receptor agonists for stroke reduction in type 2 diabetes: a call to action for neurologists. Stroke 53 (2022), 1813–1822.
Karasik, A., Lanzinger, S., Chia-Hui Tan, E., Yabe, D., Kim, D.J., Sheu, W.H., et al. Empagliflozin cardiovascular and renal effectiveness and safety compared to dipeptidyl peptidase-4 inhibitors across 11 countries in Europe and Asia: results from the EMPagliflozin compaRative effectIveness and SafEty (EMPRISE) study. Diabetes Metab, 49, 2023, 101418.
Li, C.X., Liang, S., Gao, L., Liu, H., Cardiovascular outcomes associated with SGLT-2 inhibitors versus other glucose-lowering drugs in patients with type 2 diabetes: a real-world systematic review and meta-analysis. PLoS ONE, 16, 2021, e0244689.
Lee, S.E., Nam, H., Choi, H.S., Kim, H., Kyoung, D.S., Kim, K.A., Comparative effects of sodium-glucose cotransporter 2 inhibitor and thiazolidinedione treatment on risk of stroke among patients with type 2 diabetes mellitus. Diabetes Metab J 46 (2022), 567–577.
Giugliano, D., Scappaticcio, L., Longo, M., Bellastella, G., Esposito, K., GLP-1 receptor agonists vs. SGLT-2 inhibitors: the gap seems to be leveling off. Cardiovasc Diabetol, 20, 2021, 205.
Tsai, W.H., Chuang, S.M., Liu, S.C., Lee, C.C., Chien, M.N., Leung, C.H., et al. Effects of SGLT2 inhibitors on stroke and its subtypes in patients with type 2 diabetes: a systematic review and meta-analysis. Sci Rep, 11, 2021, 15364.
Gerstein, H.C., Hart, R., Colhoun, H.M., Diaz, R., Lakshmanan, M., Botros, F.T., et al. The effect of dulaglutide on stroke: an exploratory analysis of the REWIND trial. Lancet Diabetes Endocrinol 8 (2020), 106–114.
Strain, W.D., Frenkel, O., James, M.A., Leiter, L.A., Rasmussen, S., Rothwell, P.M., et al. Effects of semaglutide on stroke subtypes in type 2 diabetes: post hoc analysis of the randomized SUSTAIN 6 and PIONEER 6. Stroke 53 (2022), 2749–2757.
Sato, K., Mano, T., Iwata, A., Toda, T., Subtype-dependent reporting of stroke with SGLT2 inhibitors: implications from a Japanese pharmacovigilance study. J Clin Pharmacol 60 (2020), 629–635.
Scheen, A.J., Antidiabetic agents and risk of atrial fibrillation/flutter: a comparative critical analysis with a focus on differences between SGLT2 inhibitors and GLP-1 receptor agonists. Diabetes Metab, 48, 2022, 101390.
Ong, H.T., Teo, Y.H., Teo, Y.N., Syn, N.L., Wee, C.F., Leong, S., et al. Effects of sodium/glucose cotransporter inhibitors on atrial fibrillation and stroke: a meta-analysis. J Stroke Cerebrovasc Dis, 31, 2022, 106159.
Hsieh, C.Y., Sung, S.F., From kidney protection to stroke prevention: the potential role of sodium glucose cotransporter-2 inhibitors. Int J Mol Sci, 24, 2022, 351.
Proietti, R., Rivera-Caravaca, J.M., Lopez-Galvez, R., Harrison, S.L., Marin, F., Underhill, P., et al. Cerebrovascular, cognitive and cardiac benefits of SGLT2 inhibitors therapy in patients with atrial fibrillation and type 2 diabetes mellitus: results from a global federated health network analysis. J Clin Med, 12, 2023, 2814.
Chang, S.N., Chen, J.J., Huang, P.S., Wu, C.K., Wang, Y.C., Hwang, J.J., et al. Sodium-glucose cotransporter-2 inhibitor prevents stroke in patients with diabetes and atrial fibrillation. J Am Heart Assoc, 12, 2023, e027764.
Kim, W., Kim, E.J., Heart failure as a risk factor for stroke. J Stroke 20 (2018), 33–45.
Berger, J.S., Peterson, E., Lalibert, E.F., Germain, G., Lejeune, D., Schein, J., et al. Risk of ischemic stroke in patients newly diagnosed with heart failure: focus on patients without atrial fibrillation. J Card Fail 25 (2019), 436–447.
Scheen, A.J., Sodium-glucose co-transporter type 2 inhibitors for the treatment of type 2 diabetes mellitus. Nat Rev Endocrinol 16 (2020), 556–577.
Gonzalez, J., Bates, B.A., Setoguchi, S., Gerhard, T., Dave, C.V, Cardiovascular outcomes with SGLT2 inhibitors versus DPP4 inhibitors and GLP-1 receptor agonists in patients with heart failure with reduced and preserved ejection fraction. Cardiovasc Diabetol, 22, 2023, 54.
Sattar, N., Lee, M.M.Y., Kristensen, S.L., Branch, K.R.H., Del Prato, S., Khurmi, N.S., et al. Cardiovascular, mortality, and kidney outcomes with GLP-1 receptor agonists in patients with type 2 diabetes: a systematic review and meta-analysis of randomised trials. Lancet Diabetes Endocrinol 9 (2021), 653–662.
He, G., Yang, G., Huang, X., Luo, D., Tang, C., Zhang, Z., SGLT2 inhibitors for prevention of primary and secondary cardiovascular outcomes: a meta-analysis of randomized controlled trials. Heart Lung 59 (2023), 109–116.
Marsico, F., Paolillo, S., Gargiulo, P., Bruzzese, D., Dell'Aversana, S., Esposito, I., et al. Effects of glucagon-like peptide-1 receptor agonists on major cardiovascular events in patients with Type 2 diabetes mellitus with or without established cardiovascular disease: a meta-analysis of randomized controlled trials. Eur Heart J 41 (2020), 3346–3358.
Kidney disease: improving global outcomes diabetes work G. KDIGO 2022 clinical practice guideline for diabetes management in chronic kidney disease. Kidney Int 102 (2022), S1–S127.
Lin, D.S., Yu, A.L., Lo, H.Y., Lien, C.W., Lee, J.K., Chiang, F.T., et al. Differential effects of sodium-glucose cotransporter 2 inhibitors on cardiovascular and renal outcomes according to renal function: a dose-response meta-analysis involving 10 randomized clinical trials and 71 553 individuals. Eur J Endocrinol 189 (2023), S17–S25.
Jong, G.P., Lin, T.K., Liao, P.L., Huang, J.Y., Yang, T.Y., Pan, L.F., Risk of new-onset stroke in patients with type 2 diabetes with chronic kidney disease on sodium-glucose co-transporter-2 inhibitor users. Transl Stroke Res, 2023, 10.1007/s12975-023-01174-0 Jul 14.
Yamada, T., Wakabayashi, M., Bhalla, A., Chopra, N., Miyashita, H., Mikami, T., et al. Cardiovascular and renal outcomes with SGLT-2 inhibitors versus GLP-1 receptor agonists in patients with type 2 diabetes mellitus and chronic kidney disease: a systematic review and network meta-analysis. Cardiovasc Diabetol, 20, 2021, 14.
Kelly, M., Lewis, J., Rao, H., Carter, J., Portillo, I., Beuttler, R., 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. Pharmacother 42 (2022), 921–928.
Marx, N., Husain, M., Lehrke, M., Verma, S., Sattar, N., GLP-1 receptor agonists for the reduction of atherosclerotic cardiovascular risk in patients with type 2 diabetes. Circulation 146 (2022), 1882–1894.
Turan, B., Durak, A., Olgar, Y., Tuncay, E., Comparisons of pleiotropic effects of SGLT2 inhibition and GLP-1 agonism on cardiac glucose intolerance in heart dysfunction. Mol Cell Biochem 477 (2022), 2609–2625.
Wu, Q., Li, D., Huang, C., Zhang, G., Wang, Z., Liu, J., et al. Glucose control independent mechanisms involved in the cardiovascular benefits of glucagon-like peptide-1 receptor agonists. Biomed Pharmacother, 153, 2022, 113517.
Qiu, M., Ding, L.L., Zhang, M., Lin, J.H., Wei, X.B., Huang, H., GLP-1RAs and SGLT2is reduce cardiovascular events independent of reductions of systolic blood pressure and body weight: a meta-analysis with meta-regression. Diabetes Ther 11 (2020), 2429–2440.
Diallo, A., Carlos-Bolumbu, M., Galtier, F., Blood pressure-lowering effects of SGLT2 inhibitors and GLP-1 receptor agonists for preventing of cardiovascular events and death in type 2 diabetes: a systematic review and meta-analysis. Acta Diabetol, 2023, 10.1007/s00592-023-2154-4 Jul 13.
Yang, X., Qiang, Q., Li, N., Feng, P., Wei, W., Holscher, C., Neuroprotective mechanisms of glucagon-like peptide-1-based therapies in ischemic stroke: an update based on preclinical research. Front Neurol, 13, 2022, 844697.
Dong, M., Wen, S., Zhou, L., The relationship between the blood-brain-barrier and the central effects of glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter-2 inhibitors. Diabetes Metab Syndr Obes 15 (2022), 2583–2597.
Maskery, M.P., Holscher, C., Jones, S.P., Price, C.I., Strain, W.D., Watkins, C.L., et al. Glucagon-like peptide-1 receptor agonists as neuroprotective agents for ischemic stroke: a systematic scoping review. J Cereb Blood Flow Metab 41 (2021), 14–30.
Verges, B., Aboyans, V., Angoulvant, D., Boutouyrie, P., Cariou, B., Hyafil, F., et al. Protection against stroke with glucagon-like peptide-1 receptor agonists: a comprehensive review of potential mechanisms. Cardiovasc Diabetol, 21, 2022, 242.
Rastogi, A., Januzzi, J.L. Jr., Pleiotropic effects of sodium-glucose cotransporter-2 inhibitors in cardiovascular disease and chronic kidney disease. J Clin Med, 12, 2023, 2824.
Bonnet, F., Scheen, A.J., Effects of SGLT2 inhibitors on systemic and tissue low-grade inflammation: potential contribution for diabetic complications and cardiovascular disease. Diabetes Metab 44 (2018), 457–464.
Cheng, A.Y.Y., Why choose between SGLT2 inhibitors and GLP1-RA when you can use both?: the time to act is now. Circulation 143 (2021), 780–782.
Gourdy, P., Darmon, P., Dievart, F., Halimi, J.M., Guerci, B., Combining glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT2is) in patients with type 2 diabetes mellitus (T2DM). Cardiovasc Diabetol, 22, 2023, 79.
Wang, S.V., Schneeweiss, S., Initiative, R.-D., Franklin, J.M., Desai, R.J., Feldman, W., et al. Emulation of randomized clinical trials with nonrandomized database analyses: results of 32 clinical trials. JAMA 329 (2023), 1376–1385.
Thompson, D., Replication of randomized, controlled trials using real-world data: what could go wrong?. Value Health 24 (2021), 112–115.
Butterly, E., Wei, L., Adler, A.I., Almazam, S.A.M., Alsallumi, K., Blackbourn, L.A.K., et al. Calibrating a network meta-analysis of diabetes trials of sodium glucose cotransporter 2 inhibitors, glucagon-like peptide-1 receptor analogues and dipeptidyl peptidase-4 inhibitors to a representative routine population: a systematic review protocol. BMJ Open, 12, 2022, e066491.
Cipriani, A., Higgins, J.P., Geddes, J.R., Salanti, G., Conceptual and technical challenges in network meta-analysis. Ann Intern Med 159 (2013), 130–137.
Ho, P.M., Peterson, P.N., Masoudi, F.A., Evaluating the evidence: is there a rigid hierarchy?. Circulation 118 (2008), 1675–1684.
Scheen, A.J., GLP-1 receptor agonists and cardiovascular protection. Class effect or not ?. Diabetes Metab 44 (2018), 193–196.
Qiu, M., Ding, L.L., Wei, X.B., Liu, S.Y., Zhou, H.R., Comparative efficacy of glucagon-like peptide 1 receptor agonists and sodium glucose cotransporter 2 inhibitors for prevention of major adverse cardiovascular events in type 2 diabetes: a network meta-analysis. J Cardiovasc Pharmacol 77 (2021), 34–37.
Duan, X.Y., Liu, S.Y., Yin, D.G., Comparative efficacy of 5 sodium glucose cotransporter 2 inhibitor and 7 glucagon-like peptide 1 receptor agonists interventions on cardiorenal outcomes in type 2 diabetes patients: a network meta-analysis based on cardiovascular or renal outcome trials. Medicine (Baltimore), 100, 2021, e26431.
Wei, X.B., Wei, W., Ding, L.L., Liu, S.Y., Comparison of the effects of 10 GLP-1 RA and SGLT2 inhibitor interventions on cardiovascular, mortality, and kidney outcomes in type 2 diabetes: a network meta-analysis of large randomized trials. Prim Care Diabetes 15 (2021), 208–211.
Pitt, B., Bhatt, D.L., Does SGLT1 inhibition add benefit to SGLT2 inhibition in type 2 diabetes?. Circulation 144 (2021), 4–6.
Morton, J.I., Marquina, C., Shaw, J.E., Liew, D., Polkinghorne, K.R., Ademi, Z., et al. Projecting the incidence and costs of major cardiovascular and kidney complications of type 2 diabetes with widespread SGLT2i and GLP-1 RA use: a cost-effectiveness analysis. Diabetologia 66 (2023), 642–656.
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