242-OR: Do GLP-1RA and SGLT2i Reduce Cardiovascular Mortality in African-American Patients with Type 2 Diabetes? A Meta-analysis

• Published in: Diabetes (New York, N.Y.) Vol. 68; no. Supplement_1
• Main Authors: MISHRIKY, BASEM M., POWELL, JAMES R., WITTWER, JENNIFER A., CHU, JENNIFER X., SEWELL, KERRY, WU, QIANG, CUMMINGS, DOYLE M.
• Format: Journal Article
• Language: English
• Published: New York American Diabetes Association 01-06-2019
• Subjects: African Americans; Cardiovascular diseases; Clinical trials; Diabetes; Diabetes mellitus; Diabetes mellitus (non-insulin dependent); Statistical analysis
• ISSN: 0012-1797; 1939-327X
• DOI: 10.2337/db19-242-OR

While patients enrolled in the cardiovascular safety trials (CVST) for GLP-1RA and SGLT2i were mostly whites, the ADA’s updated recommendations are being generalized to all races. This raises a controversial question regarding the ability to generalize CVST results to African American (AA) patients.
We searched MEDLINE, EMBASE, and CENTRAL looking for CVST comparing diabetic medications to placebo in type 2 diabetes and reporting a statistically significant lower incidence of either the primary outcome of MACE or any of the pre-specified secondary outcomes. We then extracted cardiovascular outcomes for AA patients. Sensitivity and subgroup analyses were performed according to the class of diabetic medications.
We included 6 trials (GLP-1RA in 4; SGLT2i in 2). While those trials enrolled 53,978 patients, only 2794 were AA. There was no significant difference in CV outcomes between diabetic medications (GLP-1RA or SGLT2i) and placebo in AA patients (RR [95% CI] = 0.97 [0.68, 1.39]). On restricting the analysis to GLP-1RA, then to SGLT2i, results for AA patients remained non-significant. On comparing results for GLP-1RA to those with SGLT2i, there was no difference between the groups.
We conclude that AA are not well represented in CVST. Because cardiovascular outcomes were not significantly improved for AA, it remains unclear whether GLP-1RA or SGLT2i would reduce cardiovascular risk in AA.