Butler Javed, Januzzi James L, Rosenstock Julio
University of Mississippi, Jackson, Mississippi.
Massachusetts General Hospital, Boston, Massachusetts.
Diabetes Obes Metab. 2020 Aug;22(8):1243-1262. doi: 10.1111/dom.14042. Epub 2020 Apr 27.
Type 2 diabetes mellitus (T2DM) is a major risk factor for cardiovascular disease and occurs in ~25% of patients with heart failure (HF). Patients with co-morbid HF and T2DM are at elevated risk of adverse outcomes, making optimization of complementary drug therapies essential. While research is ongoing, recent advances in drug therapy, including the introduction of sacubitril/valsartan for HF with reduced ejection fraction and the finding of positive cardiovascular effects of glucose-lowering agents (particularly sodium-glucose co-transporter-2 [SGLT2] inhibitors) have the potential to transform pharmacologic management of co-morbid HF and T2DM. In this review, we provide a comprehensive overview of cardiovascular clinical trials of therapies for HF and diabetes mellitus to date and identify areas requiring further investigation. We also discuss the pathophysiologic overlap of the two diseases and explore the complementary therapeutic effects of HF and T2DM drugs, with a particular focus on sacubitril/valsartan and SGLT2 inhibitors.
2型糖尿病（T2DM）是心血管疾病的主要危险因素，约25%的心力衰竭（HF）患者患有该疾病。合并HF和T2DM的患者发生不良结局的风险升高，因此优化辅助药物治疗至关重要。虽然研究仍在进行中，但药物治疗的最新进展，包括引入用于射血分数降低的HF的沙库巴曲缬沙坦，以及发现降糖药物（特别是钠-葡萄糖协同转运蛋白2 [SGLT2]抑制剂）的心血管益处，有可能改变合并HF和T2DM的药物治疗管理。在本综述中，我们全面概述了迄今为止治疗HF和糖尿病的心血管临床试验，并确定了需要进一步研究的领域。我们还讨论了这两种疾病的病理生理重叠，并探讨了HF和T2DM药物的互补治疗作用，特别关注沙库巴曲缬沙坦和SGLT2抑制剂。
