University of Mississippi Medical Center, Jackson, MS, USA.
Metabolic Institute of America, Tarzana, CA, USA.
Eur J Heart Fail. 2020 Apr;22(4):604-617. doi: 10.1002/ejhf.1708. Epub 2020 Jan 11.
Type 2 diabetes (T2D) is associated with an increased risk of heart failure (HF), with recent reports indicating that HF with preserved ejection fraction (HFpEF) may be more common than HF with reduced ejection fraction (HFrEF) in patients with T2D. T2D and HF result in worse outcomes than either disease alone. Sodium-glucose co-transporter-2 inhibitors (SGLT-2is) have significantly improved HF outcomes in patients with T2D and may represent a new therapeutic alternative for patients with T2D at risk for or with HF. Current guidelines recommend prevention of HF through risk factor management. Once developed, treatment of HFrEF should include neurohormonal and haemodynamic modulations; however, there are no specific treatments available for HFpEF. SGLT-2is are the first class of glucose-lowering therapy to prevent HF in clinical trials and real-world studies in patients with T2D (with or without established cardiovascular disease and with or without baseline HF). Mechanistic studies suggest that SGLT-2is have beneficial effects on both systolic and diastolic function and additional systemic effects that could benefit HF outcomes. In patients with HFrEF, SGLT-2i treatment as add-on to standard HF therapy has had beneficial effects on HF outcomes, irrespective of T2D status. These results and those of ongoing outcomes trials with SGLT-2is may help establish this drug class as a treatment for HF in patients with HFrEF and HFpEF, as well as HF in patients without T2D.
2 型糖尿病（T2D）与心力衰竭（HF）风险增加相关，最近的报告表明，在 T2D 患者中，射血分数保留的心力衰竭（HFpEF）可能比射血分数降低的心力衰竭（HFrEF）更为常见。T2D 和 HF 的结局比任何一种疾病单独发生时都更差。钠-葡萄糖共转运蛋白-2 抑制剂（SGLT-2is）显著改善了 T2D 患者的 HF 结局，可能为有或无 HF 风险的 T2D 患者提供了一种新的治疗选择。目前的指南建议通过危险因素管理预防 HF。一旦发生，HFrEF 的治疗应包括神经激素和血液动力学调节；然而，HFpEF 尚无特定的治疗方法。SGLT-2is 是第一批在临床试验和 T2D 患者（有或无已确立的心血管疾病以及有或无基线 HF）真实世界研究中预防 HF 的降糖治疗药物。机制研究表明，SGLT-2is 对收缩和舒张功能均有有益影响，并具有其他可能有益于 HF 结局的全身性作用。在 HFrEF 患者中，SGLT-2i 作为标准 HF 治疗的附加治疗对 HF 结局有有益影响，无论 T2D 状态如何。这些结果以及正在进行的 SGLT-2is 结局试验的结果可能有助于将该药物类别确立为 HFrEF 和 HFpEF 以及无 T2D 的 HF 患者的治疗方法。
