Cardiovascular Benefits of GLP-1 Receptor Agonists in Patients Living with Obesity or Overweight: A Meta-analysis of Randomized Controlled Trials.

BACKGROUND: GLP-1 receptor agonists (GLP-1 RAs) have emerged as an effective therapeutic class for weight loss. However, the efficacy of these agents in reducing cardiovascular endpoints among patients living with obesity or overweight is unclear. METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing GLP-1 RAs versus placebo in patients with obesity or overweight. We searched PubMed, Cochrane, and Embase databases. A random-effects model was used to calculate risk ratios (RRs) and mean differences (MDs), with 95% confidence intervals (CIs). RESULTS: A total of 13 RCTs were included, with 30,512 patients. Compared with placebo, GLP-1 RAs reduced systolic blood pressure (MD - 4.76 mmHg; 95% CI - 6.03, - 3.50; p < 0.001; I2 = 100%) and diastolic blood pressure (MD - 1.41 mmHg; 95% CI - 2.64, - 0.17; p = 0.03; I2 = 100%). GLP-1 RA significantly reduced the occurrence of myocardial infarction (RR 0.72; 95% CI 0.61, 0.85; p < 0.001; I2 = 0%). There were no significant differences between groups in unstable angina (UA; RR 0.84; 95% CI 0.65, 1.07; p = 0.16; I2 = 0%), stroke (RR 0.91; 95% CI 0.74, 1.12; p = 0.38; I2 = 0%), atrial fibrillation (AF; RR 0.49; 95% CI 0.17, 1.43; p = 0.19; I2 = 22%), and deep vein thrombosis (RR 0.30; 95% CI 0.06, 1.40; p = 0.13; I2 = 0%). CONCLUSIONS: In patients living with obesity or overweight, GLP-1 RA reduced systolic and diastolic blood pressure and the occurrence of myocardial infarction, with a neutral effect on the occurrence of UA, stroke, AF, and deep vein thrombosis. REGISTRATION: PROSPERO identifier number CRD42023475226.

Cardiovascular benefits of GLP-1 receptor agonists in patients living with obesity or overweight: a meta-analysis of randomized controlled trials

BACKGROUND: GLP-1 receptor agonists (GLP-1 RAs) have emerged as an effective therapeutic class for weight loss. However, the efficacy of these agents in reducing cardiovascular endpoints among patients living with obesity or overweight is unclear. METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing GLP-1 RAs versus placebo in patients with obesity or overweight. We searched PubMed, Cochrane, and Embase databases. A random-effects model was used to calculate risk ratios (RRs) and mean differences (MDs), with 95% confidence intervals (CIs). RESULTS: A total of 13 RCTs were included, with 30,512 patients. Compared with placebo, GLP-1 RAs reduced systolic blood pressure (MD - 4.76 mmHg; 95% CI - 6.03, - 3.50; p < 0.001; I2 = 100%) and diastolic blood pressure (MD - 1.41 mmHg; 95% CI - 2.64, - 0.17; p = 0.03; I2 = 100%). GLP-1 RA significantly reduced the occurrence of myocardial infarction (RR 0.72; 95% CI 0.61, 0.85; p < 0.001; I2 = 0%). There were no significant differences between groups in unstable angina (UA; RR 0.84; 95% CI 0.65, 1.07; p = 0.16; I2 = 0%), stroke (RR 0.91; 95% CI 0.74, 1.12; p = 0.38; I2 = 0%), atrial fibrillation (AF; RR 0.49; 95% CI 0.17, 1.43; p = 0.19; I2 = 22%), and deep vein thrombosis (RR 0.30; 95% CI 0.06, 1.40; p = 0.13; I2 = 0%). CONCLUSIONS: In patients living with obesity or overweight, GLP-1 RA reduced systolic and diastolic blood pressure and the occurrence of myocardial infarction, with a neutral effect on the occurrence of UA, stroke, AF, and deep vein thrombosis.

Cardiovascular benefits of statin plus ezetimibe combination therapy versus statin monotherapy in acute coronary syndrome: a meta-analysis of randomized controlled trials

BACKGROUND: The efficacy of adding ezetimibe to statin therapy for event reduction in patients with acute coronary syndromes (ACS) remains a topic of ongoing debate. METHODS: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing ezetimibe plus statin versus statin monotherapy in patients with ACS. We searched PubMed, Embase, and Cochrane for eligible trials. Random-effects model was used to calculate the risk ratios (RRs), with 95% confidence intervals (CIs). Statistical analyses were performed using RStudio version 4.2.3. RESULTS: Six RCTs comprising 20,574 patients with ACS were included, of whom 10,259 (49.9%) were prescribed ezetimibe plus statin. The patient population had an average age of 63.8 years and 75.1% were male. Compared with statin monotherapy, ezetimibe plus statin significantly reduced major adverse cardiovascular events (MACE) (RR 0.93; 95% CI 0.90-0.97; p<0.01) and non-fatal myocardial infarction (RR 0.88; 95% CI 0.81-0.95; p<0.01). There was no significant difference between groups for revascularization (RR 0.94; 95% CI 0.88-1.01; p=0.07), all-cause death (RR 0.87; 95% CI 0.63-1.21; p=0.42), or unstable angina (RR 1.05; 95% CI 0.86-1.27; p=0.64). CONCLUSION: In this meta-analysis of patients with ACS, the combination of ezetimibe plus statin was associated with a reduction in MACE and non-fatal myocardial infarction, compared with statin monotherapy.

Cardiovascular impact of cancer in patients with atrial fibrillation on direct oral anticoagulants: a systematic review and meta-analysis

BACKGROUND: The impact of cancer on patients with atrial fibrillation (AF) on direct oral anticoagulants (DOACs) remains a matter of debate. METHODS: We conducted a systematic review and meta-analysis exploring the effect of personal history of cancer in patients with AF on DOACs. PubMed, Embase, and Cochrane databases were searched for relevant studies. We used the random-effects model to calculate the risk ratio (RR) and 95% confidence intervals (CIs). Statistical analyses were performed using RStudio version 4.2.3. RESULTS: A total of six studies were included, with 63,177 patients. The mean age was 74.0 years. In this population of individuals who had AF and took DOACs, a history of cancer was associated with a significant increase in major bleeding (RR 1.72; 95% CI 1.24-2.38; p<0.01), gastrointestinal (GI) bleeding (RR 2.11; 95% CI 1.25-3.57; p<0.01), and any bleeding (RR 1.54; 95% CI 1.39-1.70; p<0.01). Additionally, all-cause death was significantly higher in patients with AF and a history of cancer (RR 1.93; 95% CI 1.35-2.76; p<0.01). There was no significant difference between groups in stroke (RR 1.77; 95% CI 0.66-4.73; p=0.25), cardiovascular (CV) death (RR 0.84; 95% CI 0.57-1.23; p=0.36), or myocardial infarction (MI) (RR 1.21; 95% CI 0.82-1.79; p=0.34). CONCLUSION: Our findings suggest that major bleeding, GI bleeding, any bleeding, and all-cause mortality significantly increased in patients with AF on DOACs who have a personal history of cancer, as compared with those who do not.

Cardiovascular benefits of GLP-1 receptor agonists in patients who are obese or overweight: a meta-analysis of randomized controlled

Backgroun|D: GLP-1 receptor agonists (GLP-1 RAs) have emerged as an effective therapeutic class for weight loss. However, the efficacy of these agents in cardiovascular endpoints among patients who are obese or overweight requires additional investigation. METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing GLP-1 RAs vs. placebo in patients who are obese or overweight. PubMed, Cochrane, and Embase were searched. A random-effects model was used to calculate risk ratios (RRs) and mean differences (MDs), with 95% confidence intervals (CIs). RESULTS: A total of 12 RCTs were included, with 12,908 patients. Compared with placebo, GLP-1 RAs were associated with significant reductions in systolic blood pressure (MD -4.45 mmHg; 95% CI -5.31, -3.60; p<0.01) and diastolic blood pressure (MD -1.43 mmHg; 95% CI -2.63, -0.22; p=0.02). There were no significant differences between groups for unstable angina (UA) (RR 0.90; 95% CI 0.29-2.84; p=0.86), stroke (RR 0.65; 95% CI 0.28-1.49; p=0.30), atrial fibrillation (AF) (RR 0.87; 95% CI 0.33-2.30; p=0.78), myocardial infarction (MI) (RR 0.57; 95% CI 0.17-1.90; p=0.36), or deep vein thrombosis (RR 0.45; 95% CI 0.08-2.65; p=0.38). CONCLUSION: In patients who are overweight or obese, GLP-1 receptor agonists reduce systolic and diastolic blood pressure, with a neutral effect on the incidence of UA, stroke, AF, MI, and deep vein thrombosis.

Cardiovascular impact of cancer in patients with atrial fibrillation on warfarin: a systematic review and meta-analysis

BACKGROUND: The impact of cancer on patients with atrial fibrillation (AF) on warfarin remains a topic of ongoing debate. METHODS: We performed a systematic review and meta-analysis exploring the effect of cancer in patients with AF on warfarin. We searched PubMed, Embase, and Cochrane for eligible trials. Random-effects model was used to calculate the risk ratios (RRs), with 95% confidence intervals (CIs). Statistical analyses were performed using RStudio version 4.2.3. RESULTS: Five trials comprising 90,572 patients were included, of whom 12,239 (13.5%) had a personal history of cancer. The patient population had an average age of 72.7 years and 59.6% were male. A history of cancer was associated with a significant increase in any bleeding (RR 1.33; 95% CI 1.15- 1.53; p<0.01). There were no significant differences between groups for stroke (RR 1.05; 95% CI 0.86- 1.29; p=0.61), major bleeding (RR 1.44; 95% CI 0.95-2.18; p=0.09), cardiovascular (CV) death (RR 0.91; 95% CI 0.59-1.41; p=0.67), myocardial infarction (MI) (RR 1.42; 95% CI 0.96-2.10; p=0.08), gastrointestinal (GI) bleeding (RR 1.74; 95% CI 0.77-3.92; p=0.18), or all-cause death (RR 1.57; 95% CI 0.99-2.49; p=0.06). CONCLUSION: Among patients with AF on warfarin, a history of cancer is associated with an increased risk of any bleeding, with no significant effect on stroke, major bleeding, CV death, MI, GI bleeding, and all-cause death.

Shorter versus longer-course of antibiotic therapy for urinary tract infections in pediatric population: an updated meta-analysis.

Urinary tract infections (UTI) affect between 3% to 7.5% of the febrile pediatric population each year, being one of the most common bacterial infections in pediatrics. Nevertheless, there is no consensus in the medical literature regarding the duration of per oral (p.o.) antibiotic therapy for UTI among these patients. Therefore, our meta-analysis aims to assess the most effective therapy length in this scenario. PubMed, Cochrane, and Embase were searched for randomized controlled trials (RCTs) comparing short (≤ 5 days) with long-course (≥ 7 days) per os (p.o.) antibiotic therapy for children with UTI. Statistical analysis was performed using R Studio version 4.2.1, heterogeneity was assessed with I2 statistics, and the risk of bias was evaluated using the RoB-2 tool. Risk Ratios (RR) with p < 0.05 were considered statistically significant. Seventeen studies involving 1666 pediatric patients were included. Of these, 890 patients (53.4%) were randomized to receive short-course therapy. Patients undergoing short-course therapy showed higher treatment failure rates (RR 1.61; 95% CI 1.15-2.27; p = 0.006). Furthermore, there were no statistically significant differences between groups regarding reinfection (RR 0.73; 95% CI 0.47-1.13; p = 0156) and relapse rates (RR 1.47; 95% CI 0.8-2.71; p = 0.270).  Conclusion: In summary, our results suggest that long-course p.o. antibiotic therapy is associated with a lower rate of treatment failure when compared to short-course p.o. antibiotic therapy. There was no statistical difference between both courses regarding reinfection and relapse rates within 15 months.    PROSPERO identifier: CRD42023456745. What is Known: • Urinary tract infections (UTIs) are common in children, affecting around 7.5% of those under 18. • The optimal duration of antibiotic treatment for pediatric UTIs has been a subject of debate. What is New: • Short-course therapy (5 or fewer days) was associated with a significantly higher failure rate when compared to long-course therapy. • There was no significant difference in reinfection and relapse rates within 15 months between short and long-course therapy.

Effects of polyphenol in women with polycystic ovary syndrome: A systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: Polycystic ovary syndrome (PCOS) is an endocrinopathy with a high prevalence in women of reproductive age. Different treatments were tested to increase insulin sensitivity and hormone regulation, and recently polyphenols have emerged as a promising option for these women. We aimed to perform a systematic review and meta-analysis of randomized clinical trials (RCTs) comparing polyphenols to placebo in PCOS. DESIGN: A systematic review and meta-analysis. METHODS: PubMed, Cochrane Library, and Embase databases were searched for RCTs comparing polyphenols to placebo. Random-effects model was used to calculate the Mean Difference (MD) and Standardized Mean Difference (SMD), with 95% confidence interval (CIs). RESULTS: A total of fifteen RCTs comprising 916 patients were included, of whom 445 (49 %) received polyphenols. Compared to placebo, polyphenols significantly reduced serum insulin level (MD -2.49; 95 % CI [-3.72, -1.25]; p < 0.01), BMI levels (MD -0.12; 95 % CI [-0.18, -0.06]; p < 0.01), and LH levels (MD -0.87; 95 % CI [-1.54, -0.20]; p = 0.01). There was no significant difference between groups in testosterone levels (SMD -0.14; 95 % CI [-0.53, 0.25]; p = 0.48). CONCLUSION: In this meta-analysis polyphenols were associated with a reduction in serum insulin, LH levels, and BMI in women with PCOS, compared to placebo. These findings support the effectiveness of polyphenols in women with PCOS. SIGNIFICANT STATEMENT: There are no comprehensive systematic recommendations for polyphenols in PCOS treatment. However, increasing evidence has highlighted its substantial impact on women's health. This systematic review and meta-analysis provide evidence for the efficacy of polyphenols in reducing serum insulin, LH, and BMI in women with PCOS compared with placebo.