Toth Peter P
CGH Medical Center, Sterling IL, USA ; Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Vasc Health Risk Manag. 2014 Dec 23;11:9-23. doi: 10.2147/VHRM.S75215. eCollection 2015.
Most individuals with type 2 diabetes mellitus have or will develop multiple independent risk factors for cardiovascular disease, particularly coronary artery disease (CAD). CAD is the leading cause of morbidity and mortality among individuals with type 2 diabetes mellitus, and treating these patients is challenging. The risk of hypoglycemia, weight gain, or fluid retention with some diabetes medications should be considered when developing a treatment plan for individuals with a history of CAD or at risk for CAD. Dipeptidyl peptidase-4 inhibitors are oral antihyperglycemic agents that inhibit the breakdown of the incretin hormones glucagon-like peptide-1 and glucose-dependent insulinotropic polypeptide, resulting in increased glucose-dependent insulin secretion and suppression of glucagon secretion. Saxagliptin is a potent and selective dipeptidyl peptidase-4 inhibitor that improves glycemic control and is generally well tolerated when used as monotherapy and as add-on therapy to other antihyperglycemic medications. This review summarizes findings from recently published post hoc analyses of saxagliptin clinical trials that have been conducted in patients with and without a history of cardiovascular disease and in patients with and without various risk factors for cardiovascular disease. The results show that saxagliptin was generally well tolerated and consistently improved glycemic control, as assessed by reductions from baseline in glycated hemoglobin, fasting plasma glucose concentration, and postprandial glucose concentration, regardless of the presence or absence of baseline cardiovascular disease, hypertension, statin use, number of cardiovascular risk factors, or high Framingham 10-year cardiovascular risk score.
大多数2型糖尿病患者已经或将会出现心血管疾病，尤其是冠状动脉疾病（CAD）的多种独立危险因素。CAD是2型糖尿病患者发病和死亡的主要原因，治疗这些患者具有挑战性。在为有CAD病史或有CAD风险的患者制定治疗方案时，应考虑某些糖尿病药物导致低血糖、体重增加或液体潴留的风险。二肽基肽酶-4抑制剂是一类口服降糖药，可抑制肠促胰岛素激素胰高血糖素样肽-1和葡萄糖依赖性促胰岛素多肽的分解，从而增加葡萄糖依赖性胰岛素分泌并抑制胰高血糖素分泌。沙格列汀是一种强效且选择性的二肽基肽酶-4抑制剂，可改善血糖控制，作为单药治疗或与其他降糖药物联合治疗时，通常耐受性良好。本综述总结了最近发表的沙格列汀临床试验事后分析的结果，这些试验在有或无心血管疾病病史以及有或无心血管疾病各种危险因素的患者中进行。结果表明，无论基线时是否存在心血管疾病、高血压、他汀类药物使用情况、心血管危险因素数量或高弗雷明汉10年心血管风险评分，沙格列汀总体耐受性良好，并持续改善血糖控制，这通过糖化血红蛋白、空腹血糖浓度和餐后血糖浓度相对于基线的降低来评估。
