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Beyond Cardiology's Pillars: A Network Meta-Analysis Comparing the Recombinant Zoster Vaccine (Shingrix/RZV) with SGLT2 Inhibitors and GLP-1 Receptor Agonists for Prevention of Major Adverse Cardiovascular Events and Dementia in Adults Aged ≥50 Years
Ahmed A, Almutari k.. Research Square, 2026-05-19
Topic: Drug trials: efficacy and safety
Eligible studies reported MACE or dementia outcomes in adults ≥ 50 years for at least one of three intervention classes (RZV, SGLT2i, GLP-1 RA) versus placebo or active comparator, with follow-up ≥ 6 months. Results Ninety-three studies (N > 4,200,000) met inclusion criteria. For MACE prevention, SUCRA analysis ranked RZV highest overall when the general population (≥ 50 years, irrespective of diabetic status) was the reference frame: RZV SUCRA 0.83 (NMA-HR 0.82, 95% CrI 0.76–0.88), GLP-1 RA SUCRA 0.71 (NMA-HR 0.86, 95% CrI 0.80–0.92), SGLT2i SUCRA 0.68 (NMA-HR 0.87, 95% CrI 0.82–0.93). For dementia prevention, RZV demonstrated the most robust and consistent evidence (NMA-RR 0.82, 95% CrI 0.75–0.88; GRADE: HIGH), with vascular dementia showing the largest magnitude (RR 0.50, 95% CrI 0.38–0.65). When cost-per-MACE-prevented and cost-per-dementia-case-prevented were modelled, RZV dominated across all base-case analyses given its two-dose durability (≥ 11 years) versus requirement for indefinite daily pharmacotherapy.
Key findings
- Eligible studies reported MACE or dementia outcomes in adults ≥ 50 years for at least one of three intervention classes (RZV, SGLT2i, GLP-1 RA) versus placebo or active comparator, with follow-up ≥ 6 months.
- Results Ninety-three studies (N > 4,200,000) met inclusion criteria.
- For MACE prevention, SUCRA analysis ranked RZV highest overall when the general population (≥ 50 years, irrespective of diabetic status) was the reference frame: RZV SUCRA 0.83 (NMA-HR 0.82, 95% CrI 0.76–0.88), GLP-1 RA SUCRA 0.71 (NMA-HR 0.86, 95% CrI 0.80–0.92), SGLT2i SUCRA 0.68 (NMA-HR 0.87, 95% CrI 0.82–0.93).
- For dementia prevention, RZV demonstrated the most robust and consistent evidence (NMA-RR 0.82, 95% CrI 0.75–0.88; GRADE: HIGH), with vascular dementia showing the largest magnitude (RR 0.50, 95% CrI 0.38–0.65).
- When cost-per-MACE-prevented and cost-per-dementia-case-prevented were modelled, RZV dominated across all base-case analyses given its two-dose durability (≥ 11 years) versus requirement for indefinite daily pharmacotherapy.
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Study details
- Study designsystematic review
- Effect sizeHR 0.82; HR 0.86; HR 0.87
- Evidence strengthHigh
How this study scored 16/100
Preprint — not yet peer-reviewed. It scored 52 on the same rubric, but non-peer-reviewed sources are capped at 16, so it shows as 16. Scored zero for sample size and studied in people because the record does not state it. We have no data on times cited, citations per year, impact for its field and year, cited by studies here, still being cited, senior author's track record, institution's track record and multi-centre collaboration, so those were left out: it earned 32 of the 62 points we could judge it on, which is 52 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 2 / 10 | Tier 4 — not a peer-reviewed journal (Research Square) |
| Journal's citation record | 0 / 4 | Not a journal article, so the journal's record does not count |
| Study design | 12 / 12 | A systematic review of all the studies on the question |
| Strength of evidence | 5 / 5 | Rated “high” in our summary |
| Peer-review validation | 4 / 10 | Preprint — not yet peer-reviewed. Hosted on a preprint server. |
| How recent | 5 / 5 | 2026 — within 1 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 3 / 3 | Effect reported with a statistic (interval, p-value, ratio or similar) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | A review of other studies — randomisation is not credited here |
| Times cited | — / 7 | No citation count (not found in OpenAlex) — left out of this score |
| Citations per year | — / 5 | No citation count or no year — left out of this score |
| Impact for its field and year | — / 6 | No field-weighted citation impact (OpenAlex has none yet) — left out of this score |
| Cited by studies here | — / 6 | Not yet checked against this library's citation graph — left out of this score |
| Still being cited | — / 4 | No yearly citation counts — left out of this score |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multi-centre collaboration | — / 3 | Institutions not listed — left out of this score |
| Indexed in PubMed | 1 / 2 | Not in PubMed, but has a DOI |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 32 / 62 | Scored on 12 of 20 parts. We have no data for the rest, so they are left out: 32 of the 62 points we could judge it on is 52 out of 100. |
| Total | 52 / 100 | Capped to 16 because this is not a peer-reviewed article. |
What each of these 20 components measures, and what this score is not →
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Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
APA 7th
Ahmed, A., & k, A. (2026). Beyond Cardiology's Pillars: A Network Meta-Analysis Comparing the Recombinant Zoster Vaccine (Shingrix/RZV) with SGLT2 Inhibitors and GLP-1 Receptor Agonists for Prevention of Major Adverse Cardiovascular Events and Dementia in Adults Aged ≥50 Years. Research Square. https://doi.org/10.21203/rs.3.rs-9727771/v1
Vancouver
Ahmed A, k A. Beyond Cardiology's Pillars: A Network Meta-Analysis Comparing the Recombinant Zoster Vaccine (Shingrix/RZV) with SGLT2 Inhibitors and GLP-1 Receptor Agonists for Prevention of Major Adverse Cardiovascular Events and Dementia in Adults Aged ≥50 Years. Research Square. 2026. doi:10.21203/rs.3.rs-9727771/v1.
BibTeX
@article{ahmed2026-e5966415,
author = {Ahmed, A. and k, Almutari},
title = {{Beyond Cardiology's Pillars: A Network Meta-Analysis Comparing the Recombinant Zoster Vaccine (Shingrix/RZV) with SGLT2 Inhibitors and GLP-1 Receptor Agonists for Prevention of Major Adverse Cardiovascular Events and Dementia in Adults Aged ≥50 Years}},
journal = {Research Square},
year = {2026},
doi = {10.21203/rs.3.rs-9727771/v1},
url = {https://doi.org/10.21203/rs.3.rs-9727771/v1}
}
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