Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy.
Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy.
Trends Endocrinol Metab. 2019 Sep;30(9):578-589. doi: 10.1016/j.tem.2019.07.004. Epub 2019 Aug 7.
The latest recommendations from the American Diabetes Association and the European Association for the Study of Diabetes prioritize the use of drugs with proven cardiovascular (CV) benefit in patients with established CV disease. Especially among the glucagon-like peptide (GLP)-1 receptor agonists (GLP-1RA) class, results of cardiovascular outcomes trials (CVOT) have been heterogeneous. Baseline characteristics of the population, study design, drugs in the control arm, modifications of CV risk factors, including glycemic control, reduction of hypoglycemia, and the GLP-1RA direct effects on CV cells and tissues, were considered. Ultimately, the time of exposure to the GLP-1RA appears to be the factor most prominently explaining trial heterogeneity. Thus, the CV benefit should be regarded as a class effect of GLP-1RA, as largely similar results are seen for drugs sharing a common mechanism of action.
美国糖尿病协会和欧洲糖尿病研究协会的最新建议优先考虑在已患有心血管疾病的患者中使用具有明确心血管（CV）获益的药物。特别是在胰高血糖素样肽（GLP-1）受体激动剂（GLP-1RA）类药物中，心血管结局试验（CVOT）的结果存在异质性。人群的基线特征、研究设计、对照臂中的药物、CV 风险因素的改变，包括血糖控制、低血糖减少以及 GLP-1RA 对 CV 细胞和组织的直接作用，都被考虑在内。最终，暴露于 GLP-1RA 的时间似乎是解释试验异质性的最重要因素。因此，CV 获益应被视为 GLP-1RA 的类效应，因为具有共同作用机制的药物的结果大致相似。
