Division of Cardiology, McGill University Health Centre, Montreal, QC, Canada.
Department of Medicine, University of Mississippi Medical Centre, Jackson, MI, USA.
Diabet Med. 2019 Dec;36(12):1550-1561. doi: 10.1111/dme.14140. Epub 2019 Oct 10.
Diabetes is one the most common comorbidities among people with established heart failure. Interest in heart failure as an outcome among people with diabetes has emerged since it was shown that there was an association between increased risk of hospitalization for heart failure with use of thiazolidinediones and some dipeptidyl peptidase-4 inhibitors. Recently, sodium-glucose co-transporter-2 inhibitors were shown to lead to a reduction in the risk of cardiovascular death and hospitalization for heart failure in people with Type 2 diabetes mellitus and either cardiovascular risk factors or atherosclerotic cardiovascular disease. These findings appear to be consistent in people both with and without a baseline history of heart failure. Based on current evidence there are several clinical scenarios in which the use of sodium-glucose co-transporter-2 inhibitors would be justified for people with heart failure and atherosclerotic cardiovascular disease: (1) in people with a new diagnosis of Type 2 diabetes and for whom anti-hyperglycaemic management strategies are being considered; (2) in people with sub-optimal glycaemic control, regardless of baseline antihyperglycaemic therapy; and (3) in people with symptomatic heart failure (or other high-risk features such as recent hospitalization for heart failure), if glycaemic control is optimized and the individual is on a sulfonylurea or dipeptidyl peptidase-4 inhibitor; here, it may be reasonable to consider substituting one of those therapies for a sodium-glucose co-transporter-2 inhibitor. There are now a number of ongoing trials evaluating the role of sodium-glucose co-transporter-2 inhibitors as therapy for people with established heart failure (with preserved or with reduced ejection fraction) and regardless of the presence of diabetes. These trials will provide the evidence for the safety and efficacy of sodium-glucose co-transporter-2 inhibitors among people with established heart failure.
糖尿病是已确诊心力衰竭患者最常见的合并症之一。自从研究表明，噻唑烷二酮类药物和某些二肽基肽酶-4 抑制剂的使用与心力衰竭住院风险增加之间存在关联以来，人们对心力衰竭作为糖尿病患者的结局产生了兴趣。最近，钠-葡萄糖协同转运蛋白-2 抑制剂被证明可降低 2 型糖尿病患者发生心血管死亡和心力衰竭住院的风险，无论这些患者是否存在心血管风险因素或动脉粥样硬化性心血管疾病。这些发现似乎在有或没有心力衰竭基线史的人群中都是一致的。基于目前的证据，在几种临床情况下，钠-葡萄糖协同转运蛋白-2 抑制剂的使用对于心力衰竭和动脉粥样硬化性心血管疾病患者是合理的：（1）对于新诊断为 2 型糖尿病且正在考虑抗高血糖治疗策略的患者；（2）对于血糖控制不理想的患者，无论基线抗高血糖治疗如何；（3）对于有症状性心力衰竭（或其他高危特征，如近期心力衰竭住院）的患者，如果血糖控制得到优化且患者正在使用磺脲类药物或二肽基肽酶-4 抑制剂；在这里，考虑用这些疗法中的一种替代钠-葡萄糖协同转运蛋白-2 抑制剂可能是合理的。目前正在进行多项临床试验，评估钠-葡萄糖协同转运蛋白-2 抑制剂作为治疗已确诊心力衰竭（射血分数保留或降低）患者的作用，无论患者是否患有糖尿病。这些试验将为钠-葡萄糖协同转运蛋白-2 抑制剂在已确诊心力衰竭患者中的安全性和疗效提供证据。
