Meta-analysis of cardiovascular outcome trials assessing the impact of glucagon-like peptide-1 receptor agonists on major cardiac arrhythmias

Abstract

Objective

Glucagon-like peptide-1 receptor agonists (GLP-1RAs), a group of novel antidiabetic agents, demonstrated beneficial cardiovascular effects in recent large, placebo-controlled randomised clinical trials (RCTs); their clear antiarrhythmic benefit has not been yet underlined. The purpose of the present meta-analysis is to clarify the impact of GLP-1RAs on different types of cardiac arrhythmias.

Methods

We searched PubMed from its inception up to 8 October 2020 for all available cardiovascular and renal outcome, placebo-controlled RCTs utilising GLP-1RAs versus placebo. The present meta-analysis is reported according to the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) statement.

Results

We included data from 7 RCTs with GLP-1RAs in a total of 55,943 participants. Treatment with GLP-1RAs did not provide significant benefit in the risk for atrial fibrillation (RR = 0.81, 95%CI; 0.78–1.15, I² = 51%), atrial flutter (RR = 0.79, 95%CI; 0.53–1.16, I² = 0%), ventricular fibrillation (RR = 0.99, 95%CI; 0.48–2.04, I² = 0%), ventricular tachycardia (RR = 1.41, 95%CI; 0.87–2.28, I² = 10%), atrial tachycardia (RR = 0.63, 95%CI; 0.10–3.90, I² = 24%), sinus node dysfunction (RR = 0.70, 95%CI; 0.40–1.23, I² = 0%), ventricular extrasystoles (RR = 1.37, 95%CI; 0.56–3.30, I² = 0%), second-degree atrioventricular block (RR = 0.96, 95%CI; 0.52–1.74, I² = 0%) or complete atrioventricular block (RR = 0.78, 95%CI; 0.39–1.54, I² = 38%).

Conclusions

In patients with type 2 diabetes mellitus, treatment with GLP-1RAs does not significantly affect the risk for major cardiac arrhythmias.

Keywords:

• Glucagon-like peptide-1 receptor agonist
• type 2 diabetes
• cardiovascular disease
• arrhythmia
• atrial fibrillation

Disclosure statement

No potential conflict of interest was reported by the authors.

Author contributions

DP and CP conceived and designed the study. DP and AB performed the scientific literature search. DP and AB did literature screening. DP, AB and ET extracted data and performed quality assessment of the included studies. DP and ET did the analyses. DP, AB, MD and CP wrote the first draft of the report. All authors contributed to interpretation and edited the draft report. All authors approved the final form of the paper.