Unit of Endocrinology, Department of Medical and Surgical Sciences, University of Foggia, via Luigi Pinto, 1, 71122 Foggia, Italy.
Curr Vasc Pharmacol. 2021;19(2):233-240. doi: 10.2174/1570161118666200317150359.
Type 2 diabetes mellitus (T2DM) is a rapidly evolving global health issue associated with a markedly increased risk of cardiovascular (CV) morbidity and mortality. The hyperglycaemic milieu contributes to the development of CV complications via several pathological pathways, leading to increased arterial stiffness (AS), that can be considered as a predictor of CV events in patients with diabetes. The measurement of AS is increasingly used for the clinical assessment of patients. Several methodologies were used in extensive population studies to assess AS; the most commonly used is the pulse wave velocity (PWV). The cardio-ankle vascular index (CAVI) was developed to measure AS; it is not affected by blood pressure at the time of measurement and shows stable values in healthy persons for years. There are several potential pharmacological and non-pharmacological interventions aiming to reduce AS. Recent evidence from clinical trials suggests that newer antidiabetic drugs do not only exert glycaemic-lowering properties but also decrease CV risk. In this context, sodium glucose cotransporter- 2 inhibitors (SGLT2i) ( empagliflozin, canagliflozin and dapagliflozin) significantly reduced the risk of CV and all-cause mortality (only EMPA-REG OUTCOME study) and hospitalization for heart failure in patients with T2DM with established CV disease and/or with CV risk factors. Improved endothelial function and AS probably represents one of the mechanisms by which these drugs exert their beneficial effects. The present review aimed both to describe the association between AS and T2DM and to discuss the effectiveness of SGLT2i on vascular endothelial dysfunction and AS.
2 型糖尿病（T2DM）是一个迅速演变的全球性健康问题，与心血管（CV）发病率和死亡率的显著增加相关。高血糖环境通过多种病理途径导致 CV 并发症的发展，导致动脉僵硬度（AS）增加，这可以被认为是糖尿病患者发生 CV 事件的预测因素。AS 的测量越来越多地用于患者的临床评估。在广泛的人群研究中使用了几种方法学来评估 AS；最常用的是脉搏波速度（PWV）。心血管踝血管指数（CAVI）是为测量 AS 而开发的；它不受测量时血压的影响，并且在健康人群中多年来显示出稳定的值。有几种潜在的药理学和非药理学干预措施旨在降低 AS。来自临床试验的新证据表明，新型抗糖尿病药物不仅具有降低血糖的特性，而且还降低 CV 风险。在这种情况下，钠-葡萄糖共转运蛋白 2 抑制剂（SGLT2i）（恩格列净、卡格列净和达格列净）显著降低了 T2DM 合并已确诊 CV 疾病和/或 CV 危险因素患者的 CV 和全因死亡率（仅 EMPA-REG OUTCOME 研究）以及心力衰竭住院风险。改善内皮功能和 AS 可能是这些药物发挥其有益作用的机制之一。本综述旨在描述 AS 与 T2DM 之间的关联，并讨论 SGLT2i 对血管内皮功能障碍和 AS 的有效性。
