Metformin is a well-known antidiabetic drug with a cardioprotective effect documented in many studies. Novel antidiabetic drugs recently used in the treatment of diabetic patients had cardioprotective effects observed in patients already taking metformin. Few studied were done to monitor the cardiac effect of novel antidiabetic drugs on patients not treated with metformin.
In this study (1), a meta-analysis was performed on randomised controlled clinical trials of GLP-1RAs and SGLT-2 inhibitors as novel antidiabetic drugs on patients not on metformin at baseline. Six randomised clinical trials were included (three from each drug group) with a total of 11235 patients. Follow-up duration was ≥1 year. The primary endpoint was major adverse cardiovascular events (MACE) incidence (myocardial infarction, stroke, or cardiovascular mortality). The occurrence of hospitalisation for heart failure and cardiovascular mortality were evaluated in SGLT-2 inhibitors arm as secondary endpoint.
The results showed that both new antidiabetic drugs were associated with a significant reduction in MACE. In addition, SGLT-2 inhibitors are associated with a significant reduction in hospitalisation for heart failure or cardiovascular mortality incidence.
In this metanalyses, GLP-1RAs and SGLT-2 inhibitors reduced the incidence of MACE irrespective of the use of metformin at baseline in addition to reduced heart failure hospitalisation for SGLT-2 treated patients. These results suggest that baseline treatment with metformin may not be required in order to observe positive cardiovascular benefits with the newer antidiabetic agents.
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