J R Soc Med

CV and renal outcomes of SGLT2-Is and GLP-1 RAs: Effect of race/ethnicity

September 26, 2023

Pooled evidence from CV outcomes trials (CVOTs) shows substantial racial/ethnic differences in the cardiorenal effects of SGLT2-Is and GLP1-RAs in patients with T2D, with consistent benefits seen among White and Asian populations, and a consistent lack of evidence of benefits in Black populations.

• For this systematic review and meta-analysis, 14 unique CVOTs (7 comparing SGLT2-Is vs. placebo and 7 comparing GLP1-RAs vs. placebo) were eligible. Ethnoracial proportions of trial enrollees ranged from 66.6 to 93.2% for White populations, 1.2 to 21.6% for Asian populations, 2.4 to 8.3% for Black populations, and 0.9 to 23.1% for other populations.
• MACE: Hazard ratios (95% confidence intervals) for major adverse CV events for SGLT2-Is compared with placebo were 0.92 (0.86-0.98), 0.69 (0.53-0.92), 0.70 (0.54-0.91) for White, Asian and Hispanic/Latino populations, respectively. For Black and other populations, HRs were 1.11 (0.82-1.51) and 0.83 (0.52-1.35), respectively. For GLP1-RAs compared with placebo, HRs for White, Asian, Hispanic/Latino and other populations were 0.88 (0.80-0.97), 0.76 (0.63-0.93), 0.82 (0.70-0.95), 0.76 (0.61-0.95), respectively. For Black populations, HR was 0.88 (0.68-1.16).
• SGLT2-Is were associated with reduced risk of all other cardiorenal outcomes in White and Asian populations, except for HF hospitalizations in Asians. Among Black populations, only a reduced risk of HF hospitalization with SGLT2-I was observed.
• Regarding regional trends, SGLT1-Is reduced risk of composite CVD death/HF hospitalization in North America and Europe, whereas GLP1-RAs reduced risk of MACE in Europe.
• Authors call for further investigation into whether the differences in this study are due to issues with under-representation of Black populations and low statistical power, or racial/ethnic variations in pharmacokinetics, pharmacodynamics and safety of SGLT2-Is and GLP1-RAs.

Source:

Kunutsor SK, et al. (2023, September 21). J R Soc Med. Racial, ethnic and regional differences in the effect of sodium-glucose co-transporter 2 inhibitors and glucagon-like peptide 1 receptor agonists on cardiovascular and renal outcomes: a systematic review and meta-analysis of cardiovascular outcome trials. https://pubmed.ncbi.nlm.nih.gov/37734450/