Xu James, Rajaratnam Rohan
Cardiology Department, Level 1 CSB, Liverpool Hospital, Elizabeth Street, Liverpool, NSW, 2170, Australia.
South Western Sydney Clinical School, The University of New South Wales, Sydney, NSW, Australia.
Cardiovasc Diabetol. 2017 Feb 2;16(1):18. doi: 10.1186/s12933-017-0499-5.
Patients with type 2 diabetes mellitus have a twofold increased risk of cardiovascular mortality compared with non-diabetic individuals. There is a growing awareness that glycemic efficacy of anti-diabetic drugs does not necessarily translate to cardiovascular safety. Over the past few years, there has been a number of trials evaluating the cardiovascular effects of anti-diabetic drugs. In this review, we seek to examine the cardiovascular safety of these agents in major published trials. Metformin has with-stood the test of time and remains the initial drug of choice. The sulfonylureas, despite being the oldest oral anti-diabetic drug, has been linked to adverse cardiovascular events and are gradually being out-classed by the various other second-line agents. The glitazones are contraindicated in heart failure. The incretin-based drugs have been at the fore-front of this era of cardiovascular safety trials and their performances have been reassuring, whereas the meglitinides and the alpha-glucosidase inhibitors still lack cardiovascular outcomes data. The sodium glucose cotransporter-2 inhibitors are an exciting new addition that has demonstrated a potential for cardiovascular benefit. Many of the currently available oral anti-diabetic agents have clinically relevant cardiovascular effects. The optimal approach to the reduction of cardiovascular risk in diabetic patients should focus on aggressive management of the standard cardiovascular risk factors rather than purely on intensive glycemic control.
与非糖尿病个体相比，2型糖尿病患者心血管死亡风险增加两倍。人们越来越意识到，抗糖尿病药物的降糖效果不一定能转化为心血管安全性。在过去几年中，有多项试验评估了抗糖尿病药物的心血管效应。在本综述中，我们试图在主要已发表的试验中检验这些药物的心血管安全性。二甲双胍经受住了时间的考验，仍然是首选的初始药物。磺脲类药物尽管是最古老的口服抗糖尿病药物，但已与不良心血管事件相关联，并且逐渐被其他各种二线药物超越。噻唑烷二酮类药物在心力衰竭患者中禁用。基于肠促胰岛素的药物一直处于这个心血管安全性试验时代的前沿，它们的表现令人放心，而瑞格列奈类药物和α-葡萄糖苷酶抑制剂仍然缺乏心血管结局数据。钠-葡萄糖协同转运蛋白2抑制剂是一个令人兴奋的新成员，已显示出心血管获益的潜力。许多目前可用的口服抗糖尿病药物具有临床相关的心血管效应。降低糖尿病患者心血管风险的最佳方法应侧重于积极管理标准心血管危险因素，而不是单纯侧重于强化血糖控制。
