Oh Jaewon, Lee Seung Hyun, Lee Chan Joo, Kang Seok Min
Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.
Department of Biochemistry and Molecular Biology, Yonsei University College of Medicine, Seoul, Korea.
Korean Circ J. 2021 May;51(5):399-408. doi: 10.4070/kcj.2021.0070.
Results from cardiovascular outcome trials (CVOT) with 5 different sodium-glucose co-transporter 2 inhibitors (SGLT2i; empagliflozin, canagliflozin, dapagliflozin, ertugliflozin, sotagliflozin), initially developed for their glucose-lowering effect by blocking tubular glucose reabsorption in kidney, have been shown to decrease the risk of heart failure hospitalization (HFH) across a range of patients with and without atherosclerotic cardiovascular disease in patients with type 2 diabetes mellitus (T2DM). Following these CVOT results, SGLT2i (dapagliflozin, empagliflozin, sotagliflozin) also were reported to reduce HFH and cardiovascular death in patients with heart failure with reduced ejection fraction (HFrEF), regardless of existence or absence of T2DM. Ongoing studies have been conducted to evaluate the clinical benefit of SGLT2i (empagliflozin, dapagliflozin) in patients with heart failure with preserved ejection fraction (HFpEF). Although SGLT2i brought us to the entrance of a new era for prevention of HF incidence and worsening of HF, the search for pivotal mechanism of SGLT2i to improve our pharmacological armamentarium should continue in order to protect every HF patient from fatal progression of HF disease. In this review, we summarized the updated clinical evidences on SGLT2i (rather than basic and translational evidence) for reduction of HF risk in T2DM patients and favorable clinical outcomes in both HFrEF and HFpEF patients.
心血管结局试验（CVOT）对5种不同的钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i；恩格列净、卡格列净、达格列净、依鲁格列净、索格列净）进行了研究，这些抑制剂最初是因其通过阻断肾脏肾小管葡萄糖重吸收来降低血糖的作用而研发的，现已证明，在2型糖尿病（T2DM）患者中，无论有无动脉粥样硬化性心血管疾病，SGLT2i均可降低心力衰竭住院（HFH）风险。基于这些CVOT结果，还报告了SGLT2i（达格列净、恩格列净、索格列净）可降低射血分数降低的心力衰竭（HFrEF）患者的HFH和心血管死亡风险，无论患者是否患有T2DM。目前正在进行研究，以评估SGLT2i（恩格列净、达格列净）对射血分数保留的心力衰竭（HFpEF）患者的临床益处。尽管SGLT2i使我们进入了预防HF发病和HF恶化的新时代，但为了保护每一位HF患者免于HF疾病的致命进展，仍应继续探索SGLT2i改善我们药物治疗手段的关键机制。在本综述中，我们总结了关于SGLT2i（而非基础和转化证据）降低T2DM患者HF风险以及在HFrEF和HFpEF患者中取得良好临床结局的最新临床证据。
