General Clinical Research Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2020 Apr;83(4):327-336. doi: 10.1097/JCMA.0000000000000276.
Type 2 diabetes has become a major disease burden in twenty-first century. Both incidence and prevalence of type 2 diabetes have quadrupled between 1980 and 2004 in the whole world. Atherosclerotic cardiovascular disease (ASCVD) is the major complication of type 2 diabetes. The introduction of statins in clinical settings is the first revolution in our battle against ASCVD. Most ASCVDs could be prevented or treated with statins. However, statin failed to reduce chronic kidney diseases (CKD) and heart failure (HF). Owing to a mandate from US Food and Drug Administration in 2008 that every new antidiabetic drug should be tested in clinical trials to demonstrate its safety, we now have a good opportunity to look for better antidiabetic drugs not only to decrease blood sugar but also to decrease CVD or renal disease. Among them, glucagon-like peptide-1 receptor agonists and sodium-glucose transport protein 2 inhibitors (SGLT-2 i) are two most extensively studied ones. SGLT-2 i, in particular, prevent CKD and end-stage renal disease, and prevent HF. In the recent CREDENCE trial, canagliflozin reduced renal endpoints by 34% and end-stage renal disease by 32%. Furthermore, in the recent DAPA-HF trial, dapagliflozin decreased hospitalization for HF/cardiovascular death by 26%, and total death by 17%, in patients with HF with reduced ejection fraction, irrespective of diabetes or nondiabetes. The beneficial effects of SGLT-2 i in CKD and HF are complementary to the effects of statins. The introduction of SGLT-2 i in clinical practice is the second revolution in cardiovascular prevention.
2 型糖尿病已成为 21 世纪的主要疾病负担。在全球范围内，1980 年至 2004 年间，2 型糖尿病的发病率和患病率增加了 4 倍。动脉粥样硬化性心血管疾病（ASCVD）是 2 型糖尿病的主要并发症。他汀类药物在临床中的应用是我们对抗 ASCVD 的第一次革命。大多数 ASCVD 可以通过他汀类药物预防或治疗。然而，他汀类药物未能降低慢性肾脏病（CKD）和心力衰竭（HF）的发病率。由于美国食品和药物管理局在 2008 年的一项规定，即每一种新的抗糖尿病药物都应在临床试验中进行测试，以证明其安全性，我们现在有一个很好的机会寻找更好的抗糖尿病药物，不仅可以降低血糖，还可以降低心血管疾病或肾脏疾病的发病率。其中，胰高血糖素样肽-1 受体激动剂和钠-葡萄糖共转运蛋白 2 抑制剂（SGLT-2i）是研究最广泛的两种药物。特别是 SGLT-2i，可以预防 CKD 和终末期肾病，并预防 HF。在最近的 CREDENCE 试验中，卡格列净可使肾脏终点事件减少 34%，终末期肾病减少 32%。此外，在最近的 DAPA-HF 试验中，达格列净可使射血分数降低的心力衰竭患者因 HF/心血管死亡而住院的风险降低 26%，总死亡率降低 17%，无论患者是否患有糖尿病。SGLT-2i 在 CKD 和 HF 中的有益作用与他汀类药物的作用互补。SGLT-2i 在临床实践中的应用是心血管预防的第二次革命。
