Sanon Vani P, Patel Shalin, Sanon Saurabh, Rodriguez Ruben, Pham Son V, Chilton Robert
Division of Cardiology, University of Texas Health Science Center at San Antonio, Audie L Murphy VA Hospital, San Antonio, TX.
Interventional Cardiology-Structural Heart Disease, Cardiology Consultants at Baptist Heart and Vascular Institute, Pensacola, FL, USA.
Ther Clin Risk Manag. 2017 May 3;13:603-611. doi: 10.2147/TCRM.S97619. eCollection 2017.
One of the most feared repercussions of type 2 diabetes mellitus is the risk of adverse cardiovascular outcomes. The current antidiabetic agents on the market have had difficulty in showing cardiovascular outcome improvement. The EMPA-REG OUTCOME trial studied the sodium-glucose cotransporter 2 inhibitor empagliflozin in type 2 diabetic patients at high risk of cardiovascular events. The trial results revealed a decrease in the composite primary end points of death from cardiovascular causes, nonfatal myocardial infarction, and nonfatal stroke in those taking empagliflozin vs placebo. Those taking the medication also had a significant decrease in death from any cause, death from cardiovascular cause, and hospitalization for heart failure. The EMPA-REG trial is paradigm shifting because it demonstrates a clear mortality benefit to cardiovascular outcomes with a low side-effect profile, in contrast to prior outcome studies of hypoglycemic agents. Further studies are required to better clarify the long-term safety and efficacy of this promising class of diabetic drugs.
2型糖尿病最令人担忧的后果之一是发生不良心血管事件的风险。目前市面上的抗糖尿病药物在改善心血管结局方面存在困难。EMPA-REG OUTCOME试验研究了钠-葡萄糖协同转运蛋白2抑制剂恩格列净在有心血管事件高风险的2型糖尿病患者中的作用。试验结果显示，与服用安慰剂的患者相比，服用恩格列净的患者心血管原因死亡、非致命性心肌梗死和非致命性中风的复合主要终点有所降低。服用该药物的患者任何原因导致的死亡、心血管原因导致的死亡以及因心力衰竭住院的情况也显著减少。EMPA-REG试验具有范式转变意义，因为与之前降糖药物的结局研究相比，它显示出对心血管结局有明显的死亡率益处且副作用较小。需要进一步研究以更好地阐明这类有前景的糖尿病药物的长期安全性和有效性。
