Coch R W, Green J B
Division of Endocrinology, Metabolism and Nutrition, Duke University School of Medicine, Durham, NC, USA.
Division of Endocrinology, Metabolism and Nutrition, Duke University School of Medicine, Durham, NC, USA; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.
Nutr Metab Cardiovasc Dis. 2016 Sep;26(9):767-72. doi: 10.1016/j.numecd.2016.06.004. Epub 2016 Jun 16.
The increased risk of cardiovascular disease in patients with type 2 diabetes has been known for many years. However, until recently the cardiovascular (CV) impact of glucose lowering strategies has been inadequately understood. Major clinical trials have now investigated the impact of intensification of glycemic control upon CV outcomes, as well as the CV effects of glucose management with newer antihyperglycemic agents.
Key findings from recently completed CV outcomes trials of dipeptidyl peptidase-4 (DPP4) inhibitors, GLP-1 receptor agonists, and sodium-glucose cotransporter 2 (SGLT2) inhibitors completed thus far are reviewed and summarized.
Multiple trials designed to meet regulatory requirements for CV safety of antihyperglycemic medications have been initiated. The results of several completed CV outcomes trials clarify the risks and benefits associated with newer medications used to manage hyperglycemia in patients with type 2 diabetes, particularly in individuals at high CV risk. Important differences have been noted with respect to heart failure outcomes within the DPP4 inhibitor class, and thus far one agent in the SGLT2 inhibitor class has been found to significantly reduce rates of important CV outcomes. Robust safety related information from trials designed to assess the CV effects of diabetes therapies will permit the incorporation of outcomes-based evidence into the formulation of diabetes care guidelines.
2型糖尿病患者心血管疾病风险增加多年来已为人所知。然而，直到最近，降糖策略对心血管（CV）的影响仍未得到充分理解。现在，主要临床试验已经研究了强化血糖控制对心血管结局的影响，以及新型降糖药物进行血糖管理的心血管效应。
回顾并总结了迄今为止已完成的二肽基肽酶-4（DPP4）抑制剂、胰高血糖素样肽-1（GLP-1）受体激动剂和钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂心血管结局试验的主要发现。
已启动多项旨在满足降糖药物心血管安全性监管要求的试验。几项已完成的心血管结局试验结果阐明了用于治疗2型糖尿病患者高血糖的新型药物相关的风险和益处，尤其是在心血管高风险个体中。在DPP4抑制剂类别中，已注意到心力衰竭结局方面的重要差异，并且迄今为止已发现SGLT2抑制剂类别中的一种药物可显著降低重要心血管结局的发生率。来自旨在评估糖尿病治疗心血管效应的试验的可靠安全性相关信息，将有助于将基于结局的证据纳入糖尿病护理指南的制定中。
