Guthrie Robert
a Emergency Medicine , The Ohio State University , Dublin , OH , USA.
Postgrad Med. 2018 Mar;130(2):149-153. doi: 10.1080/00325481.2018.1423852. Epub 2018 Jan 12.
Review of: Neal B, Perkovic V, Mahaffey K, et al. Canagliflozin and cardiovascular and renal events in type 2 diabetes. N Engl J Med. 2017;377:644-657. The report combines the data from two trials, CANVAS and CANVAS-Renal, which were designed to evaluate the safety and effect of canagliflozin, an SGLT-2 inhibitor, on the appearance of cardiovascular and renal events in patients with type 2 diabetes. Enrollees were patients with type 2 diabetes of at least 30 years of age, with a glycated hemoglobin of > or equal to 7.0% and < or equal to 10.5%. Patients either had to have preexisting cardiovascular disease or to be at elevated risk for cardiovascular disease, and to have an estimated glomerular filtration rate (eGFR) of >30 ml/min. Patients were randomized to canagliflozin at doses of either 100 mg or 300 mg or matching placebo in CANVAS, and to canagliflozin 100 mg with a possible increase to 300 mg, or placebo, in CANVAS-Renal. Physicians were instructed to continue appropriate diabetic management and other therapies in accordance with the best practices in their community. There was a significant 14% reduction in the combined endpoint of cardiovascular events of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke in the canagliflozin treated patients. There was also a pattern of improvement in markers of renal disease, including the change in the level and nature of albuminuria, a 40% decrease in the glomerular filtration rate, the need for renal replacement therapy, or death from renal causes. This study expands the scope of SGLT-2 inhibitor therapy to prevent cardiovascular disease in diabetic patients beyond those with preexisting cardiovascular disease studied in the previous empagliflozin study, raising the question as to whether SGLT-2 inhibitor therapy should be considered appropriate for most, if not all, type 2 diabetes patients, not only to control hyperglycemia but also to reduce cardiovascular and renal events.
Neal B、Perkovic V、Mahaffey K等人所著的《卡格列净与2型糖尿病患者的心血管和肾脏事件》，发表于《新英格兰医学杂志》2017年；第377卷，第644 - 657页。该报告合并了两项试验CANVAS和CANVAS - Renal的数据，这两项试验旨在评估钠 - 葡萄糖协同转运蛋白2（SGLT - 2）抑制剂卡格列净对2型糖尿病患者心血管和肾脏事件发生情况的安全性及疗效。入选者为年龄至少30岁、糖化血红蛋白≥7.0%且≤10.5%的2型糖尿病患者。患者必须患有已有的心血管疾病或心血管疾病风险升高，且估算肾小球滤过率（eGFR）>30 ml/min。在CANVAS试验中，患者被随机分配接受100毫克或300毫克剂量的卡格列净或匹配的安慰剂；在CANVAS - Renal试验中，患者被随机分配接受100毫克卡格列净（可能增至300毫克）或安慰剂。医生被指示根据所在社区的最佳实践继续进行适当的糖尿病管理和其他治疗。在接受卡格列净治疗的患者中，心血管事件（心血管原因导致的死亡、非致命性心肌梗死或非致命性中风）的综合终点显著降低了14%。肾脏疾病标志物也有改善趋势，包括蛋白尿水平和性质的变化、肾小球滤过率降低40%、肾脏替代治疗需求或肾脏原因导致的死亡。本研究将SGLT - 2抑制剂治疗预防糖尿病患者心血管疾病的范围扩展至先前恩格列净研究中已有的心血管疾病患者之外，引发了一个问题，即SGLT - 2抑制剂治疗是否应被视为适用于大多数（如果不是全部）2型糖尿病患者，不仅用于控制高血糖，还用于减少心血管和肾脏事件。
