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Purpose <p>Sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 agonists have been shown to improve cardiovascular health. This meta-analysis aims to directly compare their cardiovascular outcomes in type 2 diabetes patients (T2DM).</p> Methodology <p>We searched Medline, Scopus, Cochrane, and Web of Science from inception to August 2025 for observational studies that compared SGLT2 inhibitors and GLP-1 agonists in type 2 diabetes patients and baseline cardiovascular diseases (CVD). The primary outcomes were Major Adverse Cardiovascular Events (MACE) and heart failure (HF), while the secondary outcomes included all-cause mortality, cardiovascular mortality, myocardial infarction (MI), and stroke. The pooled hazard ratio with 95% confidence interval (CI) was employed through a random-effects model, and a p-value &lt; 0.05 was considered statistically significant.</p> Results <p>Nineteen studies comprising 1,893,359 patients (1,182,641; SGLT2 inhibitors,710,718; GLP-1 agonists). Compared to GLP-1 agonist, SGLT2 inhibitor use was associated with a significant 18% reduced risk of heart failure in T2DM patients, while a non significantly reduced risk of MACE, all-cause mortality, cardiovascular mortality, myocardial infarction, and stroke. In T2DM patients with pre-existing CVD, SGLT2 inhibitors showed a significant 14% reduced risk of heart failure, 10% reduced risk of myocardial infarction, and 7% borderline reduced risk of all-cause mortality compared to GLP-1 agonists. In T2DM patients without pre-existing CVD, SGLT2 inhibitors demonstrated a significant 17% reduced risk of heart failure, with a non-significant reduction in MACE, all-cause mortality, and myocardial infarction compared to GLP-1 agonists, and a non-significantly increased risk of cardiovascular mortality and stroke.</p> Conclusion <p>Use of SGLT2 inhibitors was associated with a lower risk of HF in T2DM, along with a lower risk of HF, MI, and all-cause mortality with pre-existing CVD compared to GLP-1 agonists. However, high heterogeneity and a lack of RCTs warrant cautious clinical implications.</p>

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A systematic review and meta-analysis comparing the cardiovascular effects of sodium-glucose co-transporter-2 inhibitors and glucagon-like peptide-1 agonists in type 2 diabetes

  • 期刊论文

  • 发表日期：

    2025年10月11日

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  • Laibah Arshad Khan,
  • Khudija Sadia,
  • Rahma Naveed,
  • Rehan Khalid,
  • Rabail Faisal,
  • Abdur Rafay Bilal,
  • Ayeza Nawaz,
  • Abdullah Safdar,
  • Talha Saleh Bin Siddique,
  • Saleh Saeed Ahmad,
  • Muhammad Ubaid Hussain,
  • Muhammad Talha Asghar,
  • Wajdan Ahmad

摘要

Purpose

Sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 agonists have been shown to improve cardiovascular health. This meta-analysis aims to directly compare their cardiovascular outcomes in type 2 diabetes patients (T2DM).

Methodology

We searched Medline, Scopus, Cochrane, and Web of Science from inception to August 2025 for observational studies that compared SGLT2 inhibitors and GLP-1 agonists in type 2 diabetes patients and baseline cardiovascular diseases (CVD). The primary outcomes were Major Adverse Cardiovascular Events (MACE) and heart failure (HF), while the secondary outcomes included all-cause mortality, cardiovascular mortality, myocardial infarction (MI), and stroke. The pooled hazard ratio with 95% confidence interval (CI) was employed through a random-effects model, and a p-value < 0.05 was considered statistically significant.

Results

Nineteen studies comprising 1,893,359 patients (1,182,641; SGLT2 inhibitors,710,718; GLP-1 agonists). Compared to GLP-1 agonist, SGLT2 inhibitor use was associated with a significant 18% reduced risk of heart failure in T2DM patients, while a non significantly reduced risk of MACE, all-cause mortality, cardiovascular mortality, myocardial infarction, and stroke. In T2DM patients with pre-existing CVD, SGLT2 inhibitors showed a significant 14% reduced risk of heart failure, 10% reduced risk of myocardial infarction, and 7% borderline reduced risk of all-cause mortality compared to GLP-1 agonists. In T2DM patients without pre-existing CVD, SGLT2 inhibitors demonstrated a significant 17% reduced risk of heart failure, with a non-significant reduction in MACE, all-cause mortality, and myocardial infarction compared to GLP-1 agonists, and a non-significantly increased risk of cardiovascular mortality and stroke.

Conclusion

Use of SGLT2 inhibitors was associated with a lower risk of HF in T2DM, along with a lower risk of HF, MI, and all-cause mortality with pre-existing CVD compared to GLP-1 agonists. However, high heterogeneity and a lack of RCTs warrant cautious clinical implications.