The 2022 Canadian Cardiovascular Society (CCS) cardiorenal guideline provided clinical recommendations on sodium-glucose co-transport 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) use. Since then, additional trials of relevance for SGLT2i have been published. This update re-evaluates the clinical recommendations for using SGLTi and their indirect comparison with existing evidence on GLP-1RA as compared to the standard of care to reduce cardiorenal morbidity and mortality. We updated our existing search and screening of the literature from September 2021 to April 2023 for randomized controlled trials of SGLT2i and GLP-1RA with placebo control. We conducted risk of bias assessment, data extraction and updated our meta-analysis of studies with similar interventions and components. The certainty of the evidence was determined using GRADE. Evidence from three new trials and additional results from an updated existing trial on SGLT2i met our inclusion criteria after an updated search. Across all the included studies, the total sample size was 151,023 adults, with 90,943 in SGLT2i trials and 60,080 in GLP-1 RA trials. The mean age ranged from 59.9 to 68.4 years. Compared with standard care, the use of SGLT2i and GLP-1 RA showed significant reductions in the outcomes of cardiovascular (CV) mortality (14% & 13%), any-cause mortality (12% & 12%), major adverse CV events (MACE) (11% & 14%), heart failure (HF) hospitalization (30% & 9%), CV death or HF hospitalization (23% & 11%), and kidney composite outcome (32% & 22%). In participants with T2D, both classes demonstrated significant cardiorenal protection. But, only GLP-1RA showed a reduction in non-fatal stroke (16%) and only SGLT2i showed a reduction in HF hospitalization (30%) in this population of people living with T2D. This updated and comprehensive meta-analysis substantiates and strengthens the clinical recommendations of the CCS cardiorenal guidelines.

中文翻译：

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钠-葡萄糖协同转运蛋白 2 抑制剂对心肾结局的有效性：更新的系统评价和荟萃分析

2022 年加拿大心血管学会 (CCS) 心肾指南提供了钠-葡萄糖共转运 2 抑制剂 (SGLT2i) 和胰高血糖素样肽-1 受体激动剂 (GLP-1RA) 使用的临床建议。此后，与 SGLT2i 相关的其他试验相继发表。本次更新重新评估了使用 SGLTi 的临床建议，并与 GLP-1RA 的现有证据进行间接比较，并与降低心肾发病率和死亡率的护理标准进行比较。我们更新了 2021 年 9 月至 2023 年 4 月期间对 SGLT2i 和 GLP-1RA 与安慰剂对照的随机对照试验的现有文献检索和筛选。我们进行了偏倚风险评估、数据提取，并更新了对具有类似干预措施和组成部分的研究的荟萃分析。证据的确定性是使用 GRADE 确定的。更新搜索后，来自 SGLT2i 的三项新试验的证据以及更新的现有试验的附加结果符合我们的纳入标准。在所有纳入的研究中，总样本量为 151,023 名成人，其中 90,943 名成人参与 SGLT2i 试验，60,080 名成人参加 GLP-1 RA 试验。平均年龄为59.9岁至68.4岁。与标准治疗相比，SGLT2i 和 GLP-1 RA 的使用显示心血管 (CV) 死亡率（14% 和 13%）、全因死亡率（12% 和 12%）、主要不良 CV 事件的结果显着降低(MACE)（11% 和 14%）、心力衰竭（HF）住院（30% 和 9%）、心血管死亡或心力衰竭住院（23% 和 11%）以及肾脏复合结局（32% 和 22%）。在患有 T2D 的参与者中，这两个类别均表现出显着的心肾保护作用。但是，在 T2D 患者群体中，只有 GLP-1RA 可以减少非致命性中风 (16%)，只有 SGLT2i 可以减少心力衰竭住院率 (30%)。这项更新且全面的荟萃分析证实并强化了 CCS 心肾指南的临床建议。