Novel antidiabetics for the primary prevention of cardiopulmonary diseases

Glucagon-like peptide 1 receptor agonists (GLP1RAs) have been recommended for preventing cardiorenal events in patients with type 2 diabetes (T2D) [ [1] Davies M.J. Aroda V.R. Collins B.S. Gabbay R.A. Green J. Maruthur N.M. et al. Management of hyperglycaemia in type 2 diabetes, 2022. A consensus report by the American Diabetes Association (ada) and the European Association for the study of diabetes (EASD). Diabetologia. 2022; 65: 1925-1966https://doi.org/10.1007/s00125-022-05787-2 Crossref PubMed Scopus (198) Google Scholar ], and sodium-glucose cotransporter-2 inhibitors (SGLT2is) have been recommended for doing this in patients with T2D, heart failure (HF), or chronic kidney disease [ 1 Davies M.J. Aroda V.R. Collins B.S. Gabbay R.A. Green J. Maruthur N.M. et al. Management of hyperglycaemia in type 2 diabetes, 2022. A consensus report by the American Diabetes Association (ada) and the European Association for the study of diabetes (EASD). Diabetologia. 2022; 65: 1925-1966https://doi.org/10.1007/s00125-022-05787-2 Crossref PubMed Scopus (198) Google Scholar , 2 Heidenreich P.A. Bozkurt B. Aguilar D. Allen L.A. Byun J.J. Colvin M.M. et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines. Circulation. 2022; 145: e895-e1032https://doi.org/10.1161/CIR.0000000000001063 Crossref PubMed Scopus (1025) Google Scholar , 3 Navaneethan S.D. Zoungas S. Caramori M.L. Chan J. Heerspink H. Hurst C. et al. Diabetes management in chronic kidney disease: synopsis of the KDIGO 2022 clinical practice guideline update. Ann Intern Med. 2023; 176: 381-387https://doi.org/10.7326/M22-2904 Crossref PubMed Scopus (8) Google Scholar ]. Although these two classes of novel antidiabetics can exert the cardiovascular benefits [ [4] Ussher J.R. Drucker DJ. Glucagon-like peptide 1 receptor agonists: cardiovascular benefits and mechanisms of action. Nat Rev Cardiol. 2023; 20: 463-474https://doi.org/10.1038/s41569-023-00849-3 Crossref PubMed Scopus (10) Google Scholar , [5] Lopaschuk G.D. Verma S. Mechanisms of cardiovascular benefits of sodium glucose co-transporter 2 (sglt2) inhibitors: a state-of-the-art review. JACC Basic Transl Sci. 2020; 5: 632-644https://doi.org/10.1016/j.jacbts.2020.02.004 Crossref PubMed Scopus (356) Google Scholar ], up to now they have not been recommended to be used in individual cardiovascular diseases, such as coronary heart disease (CHD) and essential hypertension. To examine whether there is a possibility that SGLT2is and GLP1RAs could be used for the primary prevention of common cardiovascular diseases, we conducted a meta-analysis to evaluate the association between use of the two classes of novel antidiabetics and incidence of 9 kinds of cardiovascular diseases. Moreover, to verify the benefits of SGLT2is and GLP1RAs against specific respiratory diseases (e.g., chronic obstructive pulmonary disease [COPD], respiratory failure, and pneumonia) observed in several cohort studies [ 6 Pradhan R. Lu S. Yin H. Yu O. Ernst P. Suissa S. et al. Novel antihyperglycaemic drugs and prevention of chronic obstructive pulmonary disease exacerbations among patients with type 2 diabetes: population based cohort study. BMJ Br Med J. 2022; 379: e71380https://doi.org/10.1136/bmj-2022-071380 Crossref Scopus (11) Google Scholar , 7 Jeong H.E. Park S. Noh Y. Bea S. Filion K.B. Yu O. et al. Association of adverse respiratory events with sodium-glucose cotransporter 2 inhibitors versus dipeptidyl peptidase 4 inhibitors among patients with type 2 diabetes in south Korea: a nationwide cohort study. BMC Med. 2023; 21: 47https://doi.org/10.1186/s12916-023-02765-2 Crossref PubMed Scopus (3) Google Scholar , 8 Foer D. Strasser Z.H. Cui J. Cahill K.N. Boyce J.A. Murphy S.N. et al. Association of glp-1 receptor agonists with COPD exacerbations among patients with type 2 diabetes. Am J Resp Crit Care. 2023; https://doi.org/10.1164/rccm.202303-0491OC Crossref Google Scholar , 9 Au P. Tan K. Lam D. Cheung B. Wong I. Kwok W.C. et al. Association of sodium-glucose cotransporter 2 inhibitor vs dipeptidyl peptidase-4 inhibitor use with risk of incident obstructive airway disease and exacerbation events among patients with type 2 diabetes in Hong Kong. Jama Netw Open. 2023; 6e2251177https://doi.org/10.1001/jamanetworkopen.2022.51177 Crossref Scopus (2) Google Scholar ], in this meta-analysis we would also evaluate the association between use of these novel antidiabetics and incidence of 9 kinds of respiratory diseases by incorporating the data from large randomized controlled trials (RCTs).