Division of Cardiology and Center for the Prevention of Cardiovascular Disease, Department of Medicine, New York University Medical Center, New York, New York.
Division of Cardiology and Center for the Prevention of Cardiovascular Disease, Department of Medicine, New York University Medical Center, New York, New York.
J Am Coll Cardiol. 2018 Oct 9;72(15):1856-1869. doi: 10.1016/j.jacc.2018.07.071.
Type 2 diabetes mellitus (T2D) is a major risk factor for cardiovascular disease (CVD), the most common cause of death in T2D. Despite improved risk factor control, however, adults with T2D continue to experience substantial excess CVD risk. Until recently, however, improved glycemic control has not been associated with robust macrovascular benefit. The advent of 2 new classes of antihyperglycemic agents, the sodium-glucose cotransporter-2 inhibitors and the glucagon-like peptide-1 receptor agonists, and their respective large cardiovascular outcome trials, has led to a paradigm shift in how cardiologists and heath care practitioners conceptualize T2D treatment. Herein, the authors review the recent trial evidence, the potential mechanisms of action of the sodium-glucose cotransporter-2 inhibitors and the glucagon-like peptide-1 receptor agonists, safety concerns, and their use for the primary prevention of CVD as well as in diabetic patients with impaired renal function and heart failure.
2 型糖尿病（T2DM）是心血管疾病（CVD）的主要危险因素，也是 T2DM 患者的最常见死因。然而，尽管危险因素得到了改善控制，T2DM 患者仍面临着大量的 CVD 风险。直到最近，改善血糖控制与强大的大血管获益之间并没有关联。两种新型抗高血糖药物，即钠-葡萄糖共转运蛋白 2 抑制剂和胰高血糖素样肽 1 受体激动剂，以及各自的大型心血管结局试验的出现，导致了心脏病学家和医疗保健从业者对 T2DM 治疗的观念发生了转变。本文作者回顾了最近的试验证据、钠-葡萄糖共转运蛋白 2 抑制剂和胰高血糖素样肽 1 受体激动剂的潜在作用机制、安全性问题，以及它们在 CVD 的一级预防以及肾功能受损和心力衰竭的糖尿病患者中的应用。
