Background: Cardiovascular disease is the leading cause of death in patients with type 2
Objective: To assess the impact of glucagon-like peptide-1 receptor agonist (GLP1RA) therapy, compared
to placebo, on clinically relevant outcomes including all-cause mortality, cardiovascular mortality,
nonfatal myocardial infarction (MI), nonfatal stroke, and hospitalizations for heart failure, in patients
with type 2 diabetes.
Methods: EMBASE, MEDLINE, and CENTRAL were searched (inception to September 2016) for
randomized, double-blind, placebo-controlled trials of at least one year in duration that compared any
GLP1RA to placebo in patients with type 2 diabetes. Both authors independently completed the literature
search, data extraction, and risk of bias assessment. For each outcome, a Risk Ratio (RR) and 95%
Confidence Interval (CI) were calculated using a Mantel-Haenszel random effects model.
Results: Eight trials (three albiglutide, two lixisenatide, two liraglutide, one semaglutide) consisting of
21,135 patients were included. Most patients had, or were at high risk for, cardiovascular disease. Follow-
up ranged from 1-3.8 years. Trials contributing the majority of data were deemed to have a low
risk of bias. The risk of all-cause mortality was lowered by 11% in patients receiving a GLP1RA (RR
0.89, 95% CI 0.81-0.99). There was no statistically significant difference between groups with respect
to cardiovascular death, nonfatal MI, nonfatal stroke, or hospitalizations for heart failure.
Conclusion: GLP1RA therapy when compared to placebo reduced all-cause mortality in high cardiovascular
risk patients with type 2 diabetes. They did not impact cardiovascular mortality, nonfatal MI,
nonfatal stroke, or heart failure hospitalizations.