Multimedica IRCCS, Milan, Italy.
UO Diabetologia ASUR AV4, Fermo, Italy.
Diabetes Res Clin Pract. 2019 Nov;157:107835. doi: 10.1016/j.diabres.2019.107835. Epub 2019 Aug 31.
Heart failure (HF) is common in Type-2 diabetes mellitus (T2DM), and viceversa, leading to a mutual impact on prognosis. Knowledge about this complex interplay has dramatically changed recently, due to development of new glucose-lowering drugs, and to specific FDA and EMA Guidance mandating to perform cardiovascular outcome trials (CVOTs), aimed at establishing cardiovascular safety, for new anti-diabetic treatments before they enter the market. Such CVOTs have demonstrated that the effects of the new antidiabetic drugs on the mutual interactions between T2DM and HF may develop across different phases:Results of such trials can be summarized as: (a) all different classes of novel glucose-lowering drugs have good cardiovascular safety profile; (b) with respect to HF, DPP4 inhibitors might tend to increase risk; (c) sodium-glucose co-transporter 2 inhibitors (SGTLi), significantly reduce it; (d) glucagon-like peptide 1 receptor agonists (GLP1) tend to be neutral. These CVOTs data have led to guideline recommendations indicating appropriate therapy to T2DM patients with HF not at glycemic control target with metformin therapy.
心力衰竭（HF）在 2 型糖尿病（T2DM）中很常见，反之亦然，这对预后有相互影响。由于新型降糖药物的发展，以及美国食品药品监督管理局（FDA）和欧洲药品管理局（EMA）专门发布的指南要求对新的降糖治疗进行心血管结局试验（CVOT），以在进入市场之前确定其心血管安全性，最近，关于这种复杂相互作用的知识发生了巨大变化。这些 CVOT 表明，新型降糖药物对 T2DM 和 HF 之间相互作用的影响可能在不同阶段发展：这些试验的结果可以概括为：（a）所有不同类别的新型降糖药物都具有良好的心血管安全性；（b）就 HF 而言，DPP4 抑制剂可能有增加风险的趋势；（c）钠-葡萄糖共转运蛋白 2 抑制剂（SGTLi）显著降低；（d）胰高血糖素样肽 1 受体激动剂（GLP1）趋于中性。这些 CVOT 数据导致指南推荐，对于 HF 合并 T2DM 且血糖控制未达标而不能应用二甲双胍治疗的患者，应采用适当的治疗方法。
