Sarafidis Pantelis, Papadopoulos Christodoulos E, Kamperidis Vasilios, Giannakoulas George, Doumas Michael
Department of Nephrology (P.S.), Aristotle University of Thessaloniki, Greece.
Third Department of Cardiology (C.E.P.), Aristotle University of Thessaloniki, Greece.
Hypertension. 2021 May 5;77(5):1442-1455. doi: 10.1161/HYPERTENSIONAHA.121.17005. Epub 2021 Mar 29.
Chronic kidney disease (CKD) and cardiovascular disease are intimately linked. They share major risk factors, including age, hypertension, and diabetes, and common pathogenetic mechanisms. Furthermore, reduced renal function and kidney injury documented with albuminuria are independent risk factors for cardiovascular events and mortality. In major renal outcome trials and subsequent meta-analyses in patients with CKD, ACE (angiotensin-converting enzyme) inhibitors and ARBs (angiotensin II receptor blockers) were shown to effectively retard CKD progression but not to significantly reduce cardiovascular events or mortality. Thus, a high residual risk for cardiovascular disease progression under standard-of-care treatment is still present for patients with CKD. In contrast to the above, several outcome trials with SGLT-2 (sodium-glucose cotransporter-2) inhibitors and MRAs (mineralocorticoid receptor antagonists) clearly suggest that these agents, apart from nephroprotection, offer important cardioprotection in this population. This article discusses existing evidence on the effects of SGLT-2 inhibitors and MRAs on cardiovascular outcomes in patients with CKD that open new roads in cardiovascular protection of this heavily burdened population.
慢性肾脏病（CKD）与心血管疾病密切相关。它们有共同的主要危险因素，包括年龄、高血压和糖尿病，以及共同的发病机制。此外，肾功能减退和蛋白尿所记录的肾损伤是心血管事件和死亡率的独立危险因素。在主要的肾脏结局试验以及随后针对CKD患者的荟萃分析中，血管紧张素转换酶（ACE）抑制剂和血管紧张素II受体阻滞剂（ARB）被证明能有效延缓CKD进展，但不能显著降低心血管事件或死亡率。因此，CKD患者在标准治疗下仍存在心血管疾病进展的高残留风险。与上述情况相反，几项使用钠-葡萄糖协同转运蛋白2（SGLT-2）抑制剂和盐皮质激素受体拮抗剂（MRA）的结局试验明确表明，这些药物除了具有肾脏保护作用外，还为该人群提供了重要的心脏保护作用。本文讨论了关于SGLT-2抑制剂和MRA对CKD患者心血管结局影响的现有证据，这些证据为保护这个负担沉重的人群开辟了心血管保护的新途径。
