Section of Endocrinology and Diabetes, Department of Medical, Surgical, Neurological, Metabolic Sciences and Aging, L. Vanvitelli University, Naples, Italy.
Endocrine. 2018 May;60(2):224-228. doi: 10.1007/s12020-017-1418-y. Epub 2017 Sep 11.
In randomized controlled trials (RCTs), more intensive glucose control in patients with type 2 diabetes leads to a modest (9%) reduction in major cardiovascular events (MACE), associated with a 20% reduction of kidney events and 13% reduction of eye events. The FDA issued guidance in 2008 led to the conduct of numerous cardiovascular outcomes (CVOT) trials to assess cardiovascular safety of new antihyperglycemic therapies in patients with type 2 diabetes. The results of these trials show that insulin glargine, three different dipeptidyl peptidase-4 (DPP-4) inhibitors (saxagliptin, alogliptin, and sitagliptin) and lixisenatide (a glucagon like peptide-1 receptor agonist) produce no significant difference in CVOT when compared with usual care or placebo. Other trials with newer diabetes drugs, including empagliflozin and canagliflozin (two sodium-glucose co-transporter-2 inhibitors), liraglutide and semaglutide (two GLP-1 receptor agonists) succeeded in demonstrating CV benefit in people with type 2 diabetes. In the last two decades, the equation "diabetes equals myocardial infarction" have contributed to the development of preventive therapy for risk factors in diabetes. In both primary and secondary prevention, the diabetic patients with high rates of statin and aspirin treatment have improved CV outcome, as compared with non-users. The drugs used to reduce glucose levels in patients with type 2 diabetes seem important for the ultimate cardiovascular outcome: the combination of intensive glycemic control, when safely attainable, with newer diabetes drugs (empagliflozin, canagliflozin, liraglutide, and semaglutide) may decrease the incidence of MACE, nephropathy and retinopathy. Moreover, depending on the drug used, CV mortality and heart failure may also be reduced.
在随机对照试验 (RCT) 中，对 2 型糖尿病患者进行更强化的血糖控制可使主要心血管事件 (MACE) 适度减少 (9%)，同时使肾脏事件减少 20%，眼病事件减少 13%。2008 年，美国食品药品监督管理局 (FDA) 发布了指导意见，促使开展了大量心血管结局 (CVOT) 试验，以评估新型抗高血糖疗法在 2 型糖尿病患者中的心血管安全性。这些试验的结果表明，甘精胰岛素、三种不同的二肽基肽酶-4 (DPP-4) 抑制剂 (沙格列汀、阿格列汀和西格列汀) 和利西那肽 (一种胰高血糖素样肽-1 受体激动剂) 在与常规治疗或安慰剂相比，在 CVOT 方面没有显著差异。其他使用新型糖尿病药物的试验，包括恩格列净和卡格列净 (两种钠-葡萄糖共转运蛋白-2 抑制剂)、利拉鲁肽和司美格鲁肽 (两种 GLP-1 受体激动剂)，成功证明了这些药物在 2 型糖尿病患者中的心血管益处。在过去的二十年中，“糖尿病等于心肌梗死”的说法促使人们对糖尿病的危险因素进行了预防治疗。在一级和二级预防中，与非使用者相比，使用他汀类药物和阿司匹林治疗的糖尿病患者的心血管结局得到了改善。用于降低 2 型糖尿病患者血糖水平的药物对最终的心血管结局似乎很重要：在安全可行的情况下，将强化血糖控制与新型糖尿病药物 (恩格列净、卡格列净、利拉鲁肽和司美格鲁肽) 联合使用，可能会降低 MACE、肾病和视网膜病变的发生率。此外，根据所用药物的不同，心血管死亡率和心力衰竭也可能降低。
