Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, Qatar.
College of Pharmacy, QU Health, Qatar University, Doha, Qatar.
Clin Ther. 2020 Nov;42(11):e242-e249. doi: 10.1016/j.clinthera.2020.09.008. Epub 2020 Sep 29.
Stroke is the second leading cause of death and the third leading cause of disability worldwide. Diabetes mellitus and the associated hyperglycemia are important risk factors for acute ischemic stroke and are associated with poor prognosis. Neurovascular protection is an important therapeutic target to achieve in patients with stroke, especially in those receiving thrombolytic reperfusion therapy. Sodium glucose-linked cotransporter 2 (SGLT2) inhibitors are a novel class of antidiabetic agents that target SGLT2. Hyperglycemia exacerbates the neuronal damage through the SGLT2 transporter. The purpose of this narrative review is to discuss the pleiotropic effects of SGLT2 inhibitors and their role in the treatment and prevention of ischemic stroke in experimental and clinical studies.
We searched the PubMed database using different term combinations from the date of inception to May 2019. Deselection methods were followed to exclude unrelated articles. The total number of articles included was 14.
In experimental models, SGLT2 inhibitors have a protective mechanism against neuronal dysfunction and damage through various mechanisms. From a clinical perspective and based on current evidence, SGLT2 inhibitors reduce the risk of cardiovascular events, especially in patients with heart failure.
SGLT inhibitors may have neurologic and/or vascular protective effect after acute ischemic stroke based on experimental studies. However, getting an accurate judgment of this effect is hard to achieve because only a few animal studies are available. Furthermore, and unlike animale studies, clinical studies provided uncertain answers on whether SGLT2 inhibitors would provide neuroprotective effect. In addition, several studies used combination of drugs along with SGLT2 inhibitors.
It is unlikely that SGLT inhibitors have a positive or negative effect on stroke risk, but the question that remains unanswered is whether SGLT inhibitors can yield a protective effect after acute ischemic stroke. Future observational studies and registries may be the first step to help answer this question.
脑卒中是全球范围内第二大致死原因和第三大致残原因。糖尿病及其相关的高血糖是急性缺血性脑卒中的重要危险因素，并与不良预后相关。神经血管保护是脑卒中患者的一个重要治疗靶点，特别是在接受溶栓再灌注治疗的患者中。钠-葡萄糖共转运蛋白 2（SGLT2）抑制剂是一种新型的抗糖尿病药物，作用靶点为 SGLT2。高血糖通过 SGLT2 转运体加重神经元损伤。本综述的目的是讨论 SGLT2 抑制剂的多效性作用及其在实验和临床研究中在缺血性脑卒中治疗和预防中的作用。
我们使用不同的术语组合从成立日期到 2019 年 5 月在 PubMed 数据库中进行搜索。采用排除法排除不相关的文章。纳入的文章总数为 14 篇。
在实验模型中，SGLT2 抑制剂通过多种机制对神经元功能障碍和损伤具有保护机制。从临床角度来看，根据目前的证据，SGLT2 抑制剂降低了心血管事件的风险，特别是心力衰竭患者。
基于实验研究，SGLT 抑制剂在急性缺血性脑卒中后可能具有神经和/或血管保护作用。然而，由于仅有少数动物研究，因此很难对这种作用做出准确判断。此外，与动物研究不同，临床研究对于 SGLT2 抑制剂是否会产生神经保护作用提供了不确定的答案。此外，一些研究使用了药物联合 SGLT2 抑制剂。
SGLT 抑制剂不太可能对卒中风险产生积极或消极的影响，但仍未回答的问题是 SGLT 抑制剂是否可以在急性缺血性卒中后产生保护作用。未来的观察性研究和登记可能是回答这个问题的第一步。
