Gallwitz Baptist
Medizinische Klinik IV, University of Tübingen, Tübingen, Germany.
Eur Endocrinol. 2018 Apr;14(1):17-23. doi: 10.17925/EE.2018.14.1.17. Epub 2018 Apr 18.
Type 2 diabetes (T2D) is associated with numerous comorbidities that significantly reduce quality of life, increase mortality and complicate treatment decisions. In a recent cardiovascular outcomes trial, Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients (EMPA-REG OUTCOME), the sodium-glucose cotransporter 2 (SGLT2) inhibitor empagliflozin was shown to reduce cardiovascular (CV) mortality and heart failure in high-risk patients with T2D with a previous CV event or with established CV disease (CVD). Recently published data from the Canagliflozin Cardiovascular Assessment Study (CANVAS-PROGRAM) study suggested that the cardiovascular benefits of empagliflozin are also seen with the SGLT2-inhibitor canagliflozin, indicating a class effect of SGLT2 inhibitors. Evidence for a class effect has also been shown by meta-analyses and real-world studies, including the Comparative Effectiveness of Cardiovascular Outcomes in New Users of SGLT-2 Inhibitors (CVD-REAL) and The Health Improvement Network (THIN) databases. These findings also suggest the results of EMPA-REG OUTCOME can be applied to patients with T2D with a broader CV risk profile, including people at low risk of CVD.
2型糖尿病(T2D)与众多合并症相关,这些合并症会显著降低生活质量、增加死亡率并使治疗决策复杂化。在最近一项心血管结局试验——2型糖尿病患者恩格列净心血管结局事件试验(EMPA-REG OUTCOME)中,钠-葡萄糖协同转运蛋白2(SGLT2)抑制剂恩格列净被证明可降低既往有心血管事件或已确诊心血管疾病(CVD)的T2D高危患者的心血管(CV)死亡率和心力衰竭发生率。最近发表的卡格列净心血管评估研究(CANVAS-PROGRAM)的数据表明,SGLT2抑制剂卡格列净也具有恩格列净的心血管益处,这表明SGLT2抑制剂具有类效应。荟萃分析和真实世界研究也证明了类效应,包括SGLT-2抑制剂新使用者心血管结局的比较有效性(CVD-REAL)和健康改善网络(THIN)数据库。这些发现还表明,EMPA-REG OUTCOME的结果可应用于具有更广泛CV风险特征的T2D患者,包括CVD低风险人群。