Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.
Diabetes Research Centre, University of Leicester, Leicester, UK.
Heart. 2020 Jan;106(1):18-23. doi: 10.1136/heartjnl-2019-315758. Epub 2019 Sep 24.
In recent large-scale cardiovascular outcome trials, two new classes of glucose-lowering medications-sodium glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RAs)-demonstrated cardiovascular benefits in adults with type 2 diabetes mellitus (T2DM). These findings have prompted growing optimism among clinicians regarding the potential for these agents to reduce the burden of cardiovascular disease in people with T2DM. GLP-1RAs and SGLT2i are now advocated as second-line agents in European and US guidelines for management of both hyperglycaemia and for primary prevention of cardiovascular disease in people with T2DM. Given the high prevalence of T2DM in patients with cardiovascular disease, cardiologists will increasingly encounter these agents in routine clinical practice. In this review, we summarise evidence from cardiovascular outcome trials of GLP-1RAs and SGLT2i, give practical advice on prescribing and detail safety considerations associated with their use. We also highlight areas where further work is needed, giving details on active clinical trials. The review aims to familiarise cardiologists with these emerging treatments, which will be increasingly encountered in clinical practice, given the expanding representation of T2DM in patients with cardiovascular disease. Whether these drugs will be initiated by cardiologists remains to be determined.
在最近的大型心血管结局试验中，两种新型的降糖药物——钠-葡萄糖共转运蛋白 2 抑制剂（SGLT2i）和胰高血糖素样肽-1 受体激动剂（GLP-1RAs）——在 2 型糖尿病（T2DM）成人中显示出心血管获益。这些发现促使临床医生对这些药物降低 T2DM 患者心血管疾病负担的潜力越来越乐观。GLP-1RAs 和 SGLT2i 现在被欧洲和美国的指南推荐为治疗高血糖和 T2DM 患者心血管疾病一级预防的二线药物。鉴于心血管疾病患者中 T2DM 的高患病率，心脏病专家在常规临床实践中越来越多地遇到这些药物。在这篇综述中，我们总结了 GLP-1RAs 和 SGLT2i 的心血管结局试验证据，就处方制定提供了实用建议，并详细介绍了与使用相关的安全性考虑因素。我们还强调了需要进一步研究的领域，并详细介绍了正在进行的临床试验。鉴于心血管疾病患者中 T2DM 的比例不断增加，该综述旨在使心脏病专家熟悉这些新兴治疗方法，这些方法在临床实践中会越来越多地遇到。这些药物是否将由心脏病专家启动仍有待确定。
