达格列净对比维格列汀对合并冠心病的糖尿病患者的心脏代谢参数的影响：一项随机研究。
Effects of dapagliflozin vs vildagliptin on cardiometabolic parameters in diabetic patients with coronary artery disease: a randomised study.
机构信息
Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
出版信息
Br J Clin Pharmacol. 2019 Jun;85(6):1337-1347. doi: 10.1111/bcp.13903. Epub 2019 Apr 13.
AIMS
Sodium glucose co-transporter-2 inhibitors have been shown to reduce cardiovascular events and heart failure in type 2 diabetic (T2D) patients with high cardiovascular risk. Dipeptidyl peptidase-4 inhibitors showed neutral effects and may increase risk of heart failure. We aimed to compare cardiometabolic effects of dapagliflozin and vildagliptin in T2D patients with coronary artery disease (CAD).
METHODS
Forty-nine T2D patients with CAD were randomly assigned to dapagliflozin (n = 25) or vildagliptin (n = 24) for 6 months in a double-blind fashion. Cardiometabolic parameters were collected at baseline and at the end of treatments.
RESULTS
Mean age was 63.2 ± 7.9 years (female 46.9%). Baseline characteristics did not differ between two groups. At 6 months, HbA significantly decreased in both dapaglifozin and vildagliptin groups (0.6 ± 1.0% vs 0.8 ± 1.4%, P = 0.22, respectively). There was no difference between the changes in lipid profiles. Body mass index decreased in patients receiving dapagliflozin, whereas it increased in those receiving vildagliptin (-1.27 [95% confidence interval -2.01, -0.53] vs 1.72 [0.72, 2.72] kg, P < 0.001). The reduction in systolic blood pressure and high-sensitivity troponin T was observed in the dapagliflozin group (-9.87 [-18.00, -1.15] mmHg and 2.49 [-4.50, -0.47] pg/mL) but not in vildagliptin group (-1.97 [-9.42, 5.48] mmHg and 1.98 [-0.02, 3.97] pg/mL). The mean haemoglobin increased in the dapagliflozin group, whereas the mean platelet volume increased in the vildagliptin group. There was no significant change in the inflammatory markers in both the groups.
CONCLUSIONS
The extraglycaemic effects of dapagliflozin and vildagliptin on cardiometabolic parameters in T2D with CAD were different. The more favourable effects of dapagliflozin compared to vildagliptin may have explained the cardiovascular benefits observed only in sodium glucose co-transporter-2 inhibitors.
目的
钠-葡萄糖协同转运蛋白 2 抑制剂已被证明可降低 2 型糖尿病（T2D）合并高心血管风险患者的心血管事件和心力衰竭发生率。二肽基肽酶-4 抑制剂显示出中性作用，并且可能增加心力衰竭的风险。我们旨在比较达格列净和维格列汀在合并冠状动脉疾病（CAD）的 T2D 患者中的心脏代谢作用。
方法
49 例 T2D 合并 CAD 患者被随机分为达格列净（n=25）或维格列汀（n=24）组，进行 6 个月的双盲治疗。在基线和治疗结束时收集心脏代谢参数。
结果
平均年龄为 63.2±7.9 岁（女性占 46.9%）。两组间基线特征无差异。6 个月时，达格列净和维格列汀组的糖化血红蛋白均显著降低（分别为 0.6±1.0%和 0.8±1.4%，P=0.22）。两组间血脂谱的变化无差异。达格列净组的体重指数下降，而维格列汀组则增加（-1.27[95%置信区间-2.01，-0.53] vs 1.72[0.72，2.72]kg，P<0.001）。达格列净组的收缩压和高敏肌钙蛋白 T 降低（-9.87[-18.00，-1.15]mmHg 和 2.49[-4.50，-0.47]pg/mL），但维格列汀组未发生变化（-1.97[-9.42，5.48]mmHg 和 1.98[-0.02，3.97]pg/mL）。达格列净组的平均血红蛋白增加，而维格列汀组的平均血小板体积增加。两组的炎症标志物均无明显变化。
结论
在合并 CAD 的 T2D 患者中，达格列净和维格列汀对心脏代谢参数的降糖外作用不同。与维格列汀相比，达格列净的更有利作用可能解释了仅在钠-葡萄糖协同转运蛋白 2 抑制剂中观察到的心血管获益。
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