Department of Pharmacy Services, Brigham and Women's Hospital, Boston, Mass; Cardiovascular Division, Brigham and Women's Hospital, Boston, Mass.
VCU Health Pauley Heart Center, Virginia Commonwealth University, Richmond.
Am J Med. 2019 Jan;132(1):16-24. doi: 10.1016/j.amjmed.2018.08.019. Epub 2018 Sep 7.
Cardiovascular disease is responsible for 205 deaths per 100,000 persons annually and is the leading cause of death worldwide. The public health burden of cardiovascular disease is expected to continue to grow as the prevalence of many cardiovascular risk factors increases. Several novel classes of glucose-lowering, lipid-lowering, and weight-loss therapeutics have shown mortality benefits in outcomes trials. However, a large proportion of subjects in those trials had established cardiovascular disease, so, as a result, the role of these novel therapeutics in primary cardiovascular prevention is controversial. In this review, we highlight recent advances in the pharmacotherapeutic management of the cardiovascular risk factors of hyperglycemia, dyslipidemia, and obesity. We examine key subgroups within recent cardiovascular outcome trials, weigh the risks and benefits of several novel therapeutics, and provide practical insight into the use of these agents. Our article concludes with a look toward the future and provides the practitioner and scientist with an early view of emerging therapeutics that may play an important role in primary cardiovascular prevention.
心血管疾病每年导致每 10 万人中有 205 人死亡,是全球范围内的主要死亡原因。随着许多心血管危险因素的流行率增加,心血管疾病对公共卫生的负担预计将继续增加。一些新型的降糖、降脂和减肥治疗药物在结局试验中显示出了死亡率的益处。然而,这些试验中的很大一部分受试者已经患有心血管疾病,因此,这些新型治疗药物在一级心血管预防中的作用存在争议。在这篇综述中,我们强调了在治疗高血糖、血脂异常和肥胖等心血管危险因素方面的药物治疗的最新进展。我们检查了最近的心血管结局试验中的关键亚组,权衡了几种新型治疗药物的风险和益处,并为这些药物的使用提供了实际的见解。我们的文章最后展望了未来,并为实践者和科学家提供了新兴治疗药物的早期观点,这些治疗药物可能在一级心血管预防中发挥重要作用。