Ahmad Tariq, Riello Ralph J, Inzucchi Silvio E
Section of Cardiovascular Medicine, Yale University School of Medicine New Haven, CT, US.
Section of Endocrinology, Yale University School of Medicine New Haven, CT, US.
Eur Cardiol. 2021 Mar 30;16:e11. doi: 10.15420/ecr.2020.01.R1. eCollection 2021 Feb.
Patients with type 2 diabetes are at increased cardiovascular risk. Until recently, reductions in HbA and the use of specific glucose-lowering agents have not had a clear, reproducible benefit in reducing the incidence of cardiovascular disease. However, over the past 5 years, members of two categories of diabetes medications, sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor agonists, have been associated with improved rates of major adverse cardiovascular events when used in high-risk type 2 diabetes patients. Importantly, these effects are not necessarily linked to these agents' effects on HbA. Sodium-glucose cotransporter 2 inhibitors have also been associated with reductions in heart failure hospitalization, a benefit that appears to extend to individuals without diabetes with established heart failure. Cardiovascular specialists should become familiar with these emerging data and be prepared to implement corresponding strategies in their practice to improve the cardiovascular outcomes of their patients. Recent clinical trial data and the changing landscape of corresponding professional guidelines are reviewed. Practical recommendations for safe prescribing of these anti-diabetes drugs are provided.
2型糖尿病患者的心血管风险增加。直到最近，糖化血红蛋白（HbA）的降低以及使用特定的降糖药物在降低心血管疾病发病率方面尚未产生明确、可重复的益处。然而，在过去5年中，两类糖尿病药物，即钠-葡萄糖协同转运蛋白2抑制剂和胰高血糖素样肽-1受体激动剂，在用于高危2型糖尿病患者时，与主要不良心血管事件发生率的改善相关。重要的是，这些作用不一定与这些药物对糖化血红蛋白的作用相关。钠-葡萄糖协同转运蛋白2抑制剂还与心力衰竭住院率的降低相关，这一益处似乎也适用于已确诊心力衰竭的非糖尿病个体。心血管专科医生应熟悉这些新出现的数据，并准备好在其临床实践中实施相应策略，以改善患者的心血管结局。本文回顾了近期的临床试验数据以及相应专业指南的变化情况。还提供了这些抗糖尿病药物安全处方的实用建议。
