Effects of first-line antidiabetic drugs on the improvement of arterial stiffness: A Bayesian network meta-analysis

Jincheng Wang, Department of Epidemiology, The George Washington University, Washington, DC, USA.
Yuhan Wang, Department of Endocrinology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Yueheng Wang, Department of Ultrasound Diagnosis, The Second Hospital of Hebei Medical University, Shijiazhuang, China.
Yu Li, Department of General Internal Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Jiamei Zhang, Department of Ultrasound Diagnosis, The Second Hospital of Hebei Medical University, Shijiazhuang, China.
Han Zhang, Department of Ultrasound Diagnosis, The Second Hospital of Hebei Medical University, Shijiazhuang, China.
Xiaomin Fu, Department of Endocrinology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Zhiqin Guo, Cardiovascular department, The First Hospital of Tsinghua University, Beijing, China.
Ying Yang, Cardiovascular department, The First Hospital of Tsinghua University, Beijing, China.
Kaining Kang, Department of Geriatric Diseases, Handan Central Hospital, Handan, China.
Wei Zhang, Department of Geriatric Diseases, Handan Central Hospital, Handan, China.
Li Tian, Department of Geriatric Diseases, Handan Central Hospital, Handan, China.
Yanqiang Wu, Department of Geriatric Diseases, Handan Central Hospital, Handan, China.
Shuanli Xin, Department of Cardiology, First Hospital of Handan City, Handan, China.
Hongzhou Liu, Department of Endocrinology, First Hospital of Handan City, Handan, China.

Document Type

Journal Article

Publication Date

8-1-2023

Journal

Journal of diabetes

Volume

15

Issue

8

DOI

10.1111/1753-0407.13405

Keywords

antidiabetic drugs; arterial stiffness; cardiovascular outcome; pulse wave velocity; vascular function; 动脉硬化; 心血管结局; 脉搏波传导速度; 血管功能; 降糖药物

Abstract

BACKGROUND: Changes in vascular function are closely associated with the development of cardiovascular disease (CVD). Pulse wave velocity (PWV) is a potential indicator of vascular dysfunction; it allows noninvasive assessment of arterial stiffness. Currently, evidence for the effects of different classes of antidiabetic drugs on arterial stiffness remains limited. In this study, a network meta-analysis (NMA) was performed to explore the associations between changes in arterial stiffness and first-line antidiabetic drugs by evaluating PWV in patients with different metabolic abnormalities. METHODS: We systematically searched several electronic databases for randomized controlled trials (RCTs) published from inception until 25 August 2022, without language restrictions. The primary outcome was the change in PWV (ΔPWV) in all included studies; subgroup analysis was performed for patients with abnormal glucose metabolism, including prediabetes and diabetes mellitus. NMA was performed to calculate the mean differences (MDs) with 95% confidence intervals (CIs) as effect sizes to evaluate the ΔPWV. RESULTS: Among the 2257 candidate articles identified in the initial search, 18 RCTs were eventually included in the analysis. In all studies, two classes of new antidiabetic drugs, glucagon-like peptide-1 receptor (GLP-1R) agonists and sSodium-glucose co-transporter 2 (SGLT-2) inhibitors, improved arterial stiffness by decreasing PWV compared with placebo (MD = -1.11, 95% CI: -1.94 to 0.28) and (MD = -0.76, 95% CI: -1.45 to -0.08). A conventional antidiabetic drug, metformin, also showed similar efficacy compared with placebo (MD = -0.73, 95% CI: -1.33 to -0.12). Finally, in subgroup studies of patients with abnormal glucose metabolism diseases, GLP-1R agonists (MD = -1.06, 95% CI: -2.05 to -0.10) significantly decreased PWV compared with placebo. CONCLUSION: Three classes of antidiabetic drugs-GLP-1R agonists, SGLT-2 inhibitors, and metformin-have the potential to improve arterial stiffness. Among the six classes of antidiabetic drugs analyzed, GLP-1R agonists constitute the only class of drugs that improves arterial stiffness in patients with abnormal glucose metabolism diseases.

Department

Public Health Student Works

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