Gulsin Gaurav S, Graham-Brown Matthew P M, Squire Iain B, Davies Melanie J, McCann Gerry P
Department of Cardiovascular Sciences, University of Leicester and the Leicester NIHR Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester, UK
John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK.
Heart. 2022 Jan;108(1):16-21. doi: 10.1136/heartjnl-2021-319185. Epub 2021 May 10.
Sodium glucose cotransporter 2 inhibitors (SGLT2i) have emerged as a class of medications with positive cardiovascular (CV) effects across a spectrum of patients with and without type 2 diabetes (T2D). In heart failure with reduced ejection fraction, there is clear evidence that SGLT2i reduce hospitalisations and mortality regardless of the presence of diabetes, and they are now recognised as the fourth pillar of pharmacological management. Recent trial data also indicate promising effects in heart failure with preserved ejection fraction. In patients with T2D and atherosclerotic CV diseases, multiple CV outcomes trials have shown reductions in major adverse CV events. Meta-analysis of these trials also shows lower rates of incident and recurrent atrial fibrillation with SGLT2i. Concerns regarding utilisation in patients with chronic kidney disease have been allayed in trials showing SGLT2i in fact have renoprotective effects. Questions still remain regarding the safety of SGLT2i in the acute heart failure setting and immediately post myocardial infarction, as well as in patients with more advanced stages of chronic kidney disease. Furthermore, studies are underway evaluating SGLT2i in patients with heart valve disease, where positive effects on left ventricular remodelling may, for example, improve functional mitral regurgitation. In this review, we summarise the available evidence of recent CV outcomes trials of SGLT2i, focusing particularly on the application of these agents across various CV diseases. We detail evidence to support increased utilisation of these drugs, which in many cases will reduce mortality and improve quality of life in patients routinely encountered by the CV specialist physician.
钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）已成为一类对患有和未患有2型糖尿病（T2D）的各类患者均具有积极心血管（CV）效应的药物。在射血分数降低的心力衰竭患者中，有明确证据表明，无论是否存在糖尿病，SGLT2i均可降低住院率和死亡率，目前它们已被视为药物治疗的第四大支柱。最近的试验数据还表明，SGLT2i在射血分数保留的心力衰竭患者中也有显著疗效。在患有T2D和动脉粥样硬化性心血管疾病的患者中，多项心血管结局试验显示主要不良心血管事件有所减少。对这些试验的荟萃分析还表明，使用SGLT2i可降低房颤的发生率和复发率。在一些试验中，SGLT2i实际上具有肾脏保护作用，这消除了人们对其在慢性肾脏病患者中应用的担忧。然而，对于SGLT2i在急性心力衰竭和心肌梗死后即刻的安全性，以及在慢性肾脏病更晚期患者中的安全性，仍存在疑问。此外，正在开展研究评估SGLT2i在心脏瓣膜病患者中的应用，例如其对左心室重塑的积极作用可能会改善功能性二尖瓣反流。在本综述中，我们总结了SGLT2i近期心血管结局试验的现有证据，特别关注这些药物在各种心血管疾病中的应用。我们详细阐述了支持增加使用这些药物的证据，在许多情况下，这将降低死亡率并改善心血管专科医生日常诊治患者的生活质量。
