Effect of once-weekly exenatide on hospitalization for acute coronary syndrome or coronary revascularization in patients with type 2 diabetes mellitus

Barbery, Carlos; Giczewska, Anna; White, Jennifer A.; Lokhnygina, Yuliya; Mentz, Robert J.; Holman, Rury R.; Pagidipati, Neha J.; Hernandez, Adrian F.; Jones, W. Schuyler

doi:10.1016/j.ahj.2021.03.013

Cited by 4 publications

(3 citation statements)

References 17 publications

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“…The mean duration of diabetes in our patients was significantly lower than that of the British study 28 . This could be linked to the frequent delay in diagnosing diabetes in low‐income countries like ours and to the ageing of the population in developed countries.…”

Section: Discussioncontrasting

confidence: 70%

“…The mean duration of diabetes in our patients was significantly lower than that of the British study. 28 This could be linked to the frequent delay in diagnosing diabetes in low-income countries like ours and to the ageing of the population in developed countries. In addition, the glycemic control of our patients was poor, favouring the occurrence of these degenerative complications, especially microvascular.…”

Section: Discussionmentioning

confidence: 93%

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Epidemiological‐clinical and paraclinical particularities of acute coronary syndrome without persistent ST‐segment elevation in type 2 diabetes mellitus: Retrospective comparative study in a Malagasy population

Raharinavalona

Raherison

Razanamparany

et al. 2022

Endocrino Diabet & Metabol

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Introduction This study aimed at determining the epidemiological‐clinical and paraclinical particularities of non‐ST‐segment elevation acute coronary syndrome (NSTE‐ACS) in Malagasy with type 2 diabetes mellitus (T2DM). Methods This was a retrospective, descriptive and comparative study between patients with and without T2DM, carried out over a period of 38 months. The diagnosis of NSTE‐ACS was retained in front of the association of chest discomfort, electrical abnormalities and elevations beyond fivefold the upper reference limit of high‐sensitivity cardiac troponin. Result With 130 patients included, the overall prevalence of NSTE‐ACS was 4.1%, of which 68 patients (52.3%) had T2DM. Compared to without T2DM, NSTE‐ACS in T2DM was characterized by young age (p = .0002), high‐frequency hypertension (OR 2.92 [1.23–7.25]; p = .0041), overweight/obesity (OR 4.39 [1.72–12.4]; p = .0002) and microalbuminuria (p < .0001), accelerated heart rate (p = .0104), atypical chest discomfort (OR 5.57 [2.21–15.7]; p < .0001), pulmonary crepitations (OR 2.25 [1.02–5.14]; p = .0224), high GRACE score (p = .0016), damage of extensive anterior leads (OR 2.11 [1.02–4.98]; p = .0402) and septal lead (OR 3.64 [1.41–10.3]; p = .0015), significant increase in cardiac troponin (p < .0001), high left ventricular filling pressure (OR 3.39 [1.51–7.90]; p = .001). Conclusion NSTE‐ACS in T2DM is frequent, with an atypical clinical and severe paraclinical presentations. Adequate and multidisciplinary management of cardiovascular risk factors, including T2DM, could thus minimize the occurrence of NSTE‐ACS and improve this profile.

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Section: Discussioncontrasting

confidence: 70%

Section: Discussionmentioning

confidence: 93%

Epidemiological‐clinical and paraclinical particularities of acute coronary syndrome without persistent ST‐segment elevation in type 2 diabetes mellitus: Retrospective comparative study in a Malagasy population

Raharinavalona

Raherison

Razanamparany

et al. 2022

Endocrino Diabet & Metabol

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“…Some scholars have previously proposed a statement of differences in the overall design, participant population, and the like of the trials to explain the different effects of GLP-1RAs on cardiovascular outcomes in various studies ( 13 ). However, the underlying drivers of the variable results between GLP-1RAs and arrhythmias remain unknown.…”

Section: Introductionmentioning

confidence: 99%

A meta-analysis evaluating indirectly GLP-1 receptor agonists and arrhythmias in patients with type 2 diabetes and myocardial infarction

Liu

Bian

et al. 2022

Front. Cardiovasc. Med.

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AimsAt present, the effects of Glucagon-Like Peptide 1 Receptor agonists (GLP-1RAs) on arrhythmia in patients with type 2 diabetes mellitus (T2DM) and myocardial infarction (MI) are still unclear. Hence, this systematic review and meta-analysis aimed to investigate this association.Methods and resultsPubMed, Embase, Cochrane Library, and Web of Science were searched from inception to 30 April 2022. Randomized controlled trials (RCTs) that compared GLP-1RAs with placebo and met the critical criterion of a proportion of patients with T2DM and MI > 30% were included to verify our purpose indirectly. The outcomes of interest included atrial arrhythmias, ventricular arrhythmias, atrioventricular block (AVB), sinus arrhythmia, and cardiac arrest. Relative risk (RR) and 95% confidence intervals (CI) were pooled using a random-effects model. We included five RCTs with altogether 31,314 patients. In these trials, the highest proportion of patients with T2DM and MI was 82.6%, while the lowest was 30.7%. Compared to placebo, GLP-1RAs were associated with a lower risk of atrial arrhythmias (RR 0.81, 95% CI 0.70–0.95). There was no significant difference in the risk of ventricular arrhythmias (RR 1.26, 95% CI 0.87–1.80), AVB (RR 0.95, 95% CI 0.63–1.42), sinus arrhythmia (RR 0.62, 95% CI 0.26–1.49), and cardiac arrest (RR 0.97, 95% CI 0.52–1.83) between groups.ConclusionGLP-1RAs may be associated with reduced risk for atrial arrhythmias, which seems more significant for patients with T2DM combined with MI. More studies are needed to clarify the definitive anti-arrhythmic role of this drug.

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Treatment effect heterogeneity following type 2 diabetes treatment with GLP1-receptor agonists and SGLT2-inhibitors: a systematic review

Young,

McInnes,

Massey

et al. 2023

Commun Med

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Background A precision medicine approach in type 2 diabetes requires the identification of clinical and biological features that are reproducibly associated with differences in clinical outcomes with specific anti-hyperglycaemic therapies. Robust evidence of such treatment effect heterogeneity could support more individualized clinical decisions on optimal type 2 diabetes therapy. Methods We performed a pre-registered systematic review of meta-analysis studies, randomized control trials, and observational studies evaluating clinical and biological features associated with heterogenous treatment effects for SGLT2-inhibitor and GLP1-receptor agonist therapies, considering glycaemic, cardiovascular, and renal outcomes. After screening 5,686 studies, we included 101 studies of SGLT2-inhibitors and 75 studies of GLP1-receptor agonists in the final systematic review. Results Here we show that the majority of included papers have methodological limitations precluding robust assessment of treatment effect heterogeneity. For SGLT2-inhibitors, multiple observational studies suggest lower renal function as a predictor of lesser glycaemic response, while markers of reduced insulin secretion predict lesser glycaemic response with GLP1-receptor agonists. For both therapies, multiple post-hoc analyses of randomized control trials (including trial meta-analysis) identify minimal clinically relevant treatment effect heterogeneity for cardiovascular and renal outcomes. Conclusions Current evidence on treatment effect heterogeneity for SGLT2-inhibitor and GLP1-receptor agonist therapies is limited, likely reflecting the methodological limitations of published studies. Robust and appropriately powered studies are required to understand type 2 diabetes treatment effect heterogeneity and evaluate the potential for precision medicine to inform future clinical care.

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Effect of once-weekly exenatide on hospitalization for acute coronary syndrome or coronary revascularization in patients with type 2 diabetes mellitus

Cited by 4 publications

References 17 publications

Epidemiological‐clinical and paraclinical particularities of acute coronary syndrome without persistent ST‐segment elevation in type 2 diabetes mellitus: Retrospective comparative study in a Malagasy population

Epidemiological‐clinical and paraclinical particularities of acute coronary syndrome without persistent ST‐segment elevation in type 2 diabetes mellitus: Retrospective comparative study in a Malagasy population

A meta-analysis evaluating indirectly GLP-1 receptor agonists and arrhythmias in patients with type 2 diabetes and myocardial infarction

Treatment effect heterogeneity following type 2 diabetes treatment with GLP1-receptor agonists and SGLT2-inhibitors: a systematic review

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