Paneni Francesco, Lüscher Thomas F
University Heart Center, Cardiology, University Hospital Zurich, Switzerland; Center for Molecular Cardiology, University of Zurich, Switzerland.
University Heart Center, Cardiology, University Hospital Zurich, Switzerland; Center for Molecular Cardiology, University of Zurich, Switzerland.
Am J Med. 2017 Jun;130(6S):S18-S29. doi: 10.1016/j.amjmed.2017.04.008.
Patients with type 2 diabetes (T2DM) have a significantly higher risk of developing cardiovascular disease (CVD)-namely myocardial infarction, heart failure, and stroke. Despite clear advances in the prevention and treatment of CVD, the impact of T2DM on CVD outcome remains high and continues to escalate. Available evidence indicates that the risk of macrovascular complications increases with the severity of hyperglycemia, thus suggesting that the relation between metabolic disturbances and vascular damage is approximately linear. Although current antidiabetic drugs are highly effective for the management of hyperglycemia, most T2DM patients remain exposed to a substantial and concrete risk of CVD. Over the last decade many glucose-lowering agents have been tested for their safety and efficacy in T2DM with CVD. Noteworthy, most of these studies failed to show a significant benefit in terms of CV morbidity and mortality, despite intensive glycemic control. The recent trials Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients-Removing Excess Glucose (EMPA-REG OUTCOME); Trial to Evaluate Cardiovascular and Other Long-term Outcomes with Semaglutide in Subjects with Type 2 Diabetes (SUSTAIN-6); Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results (LEADER); and Insulin Resistance Intervention After Stroke (IRIS) have shed some light on this important clinical issue, thus showing a convincing effect of empagliflozin, liraglutide, and pioglitazone on CVD outcomes. Here we provide a critical and updated overview of the main glucose-lowering agents and their risk/benefit ratio for the prevention of CVD in patients with T2DM.
2型糖尿病（T2DM）患者发生心血管疾病（CVD）——即心肌梗死、心力衰竭和中风的风险显著更高。尽管在CVD的预防和治疗方面取得了明显进展，但T2DM对CVD结局的影响仍然很大且持续上升。现有证据表明，大血管并发症的风险随着高血糖的严重程度而增加，因此提示代谢紊乱与血管损伤之间的关系大致呈线性。虽然目前的抗糖尿病药物对高血糖的管理非常有效，但大多数T2DM患者仍然面临着实质性且确切的CVD风险。在过去十年中，许多降糖药物已在患有CVD的T2DM患者中进行了安全性和有效性测试。值得注意的是，尽管进行了强化血糖控制，但这些研究中的大多数在心血管发病率和死亡率方面未能显示出显著益处。最近的试验——2型糖尿病患者恩格列净心血管结局事件试验——清除多余葡萄糖（EMPA-REG OUTCOME）；评估司美格鲁肽对2型糖尿病患者心血管和其他长期结局的试验（SUSTAIN-6）；利拉鲁肽在糖尿病中的作用及心血管结局评估（LEADER）；以及中风后胰岛素抵抗干预（IRIS）——为这一重要的临床问题提供了一些启示，从而显示出恩格列净、利拉鲁肽和吡格列酮对CVD结局具有令人信服的作用。在此，我们对主要降糖药物及其在预防T2DM患者CVD方面的风险/效益比进行了批判性和最新的综述。
