Wijnen M, Duschek E J J, Boom H, van Vliet M
Department of Internal Medicine, Reinier de Graaf Gasthuis, Delft, The Netherlands.
Department of Endocrinology, Reinier de Graaf Gasthuis, Delft, The Netherlands.
Neth Heart J. 2022 Feb;30(2):65-75. doi: 10.1007/s12471-021-01579-2. Epub 2021 Jun 7.
In the Netherlands, approximately 250,000 people are living with heart failure. About one-third of them have comorbid diabetes mellitus type 2. Until recently, the effects of antidiabetic agents on heart failure were largely unknown. This changed after an observed increased risk of heart failure and ischaemic heart disease associated with thiazolidinediones that prompted the requirement for cardiovascular outcome trials for new glucose-lowering drugs. In the past decade, three new classes of antidiabetic agents have become available (i.e. dipeptidyl peptidase‑4 inhibitors, glucagon-like peptide‑1 receptor agonists and sodium-glucose cotransporter‑2 (SGLT2) inhibitors). Although the first two classes demonstrated no beneficial effects on heart failure compared to placebo in patients with diabetes mellitus type 2, SGLT2 inhibitors significantly and consistently lowered the risk of incident and worsening heart failure. Two recent trials indicated that these favourable effects were also present in non-diabetic patients with heart failure with reduced ejection fraction, resulting in significantly lower risks of hospitalisation for heart failure and presumably also cardiovascular and all-cause mortality. SGLT2 inhibitors have been shown to be benefit on top of recommended heart failure therapy including sacubitril/valsartan and may also prove beneficial for heart failure with preserved ejection fraction. In this review, we discuss the effects of antidiabetic agents on heart failure.
在荷兰，约有25万人患有心力衰竭。其中约三分之一同时患有2型糖尿病。直到最近，抗糖尿病药物对心力衰竭的影响在很大程度上仍不为人知。在观察到噻唑烷二酮类药物与心力衰竭和缺血性心脏病风险增加相关后，这种情况发生了变化，这促使对新型降糖药物开展心血管结局试验。在过去十年中，出现了三类新型抗糖尿病药物（即二肽基肽酶-4抑制剂、胰高血糖素样肽-1受体激动剂和钠-葡萄糖协同转运蛋白-2（SGLT2）抑制剂）。尽管与安慰剂相比，前两类药物对2型糖尿病患者的心力衰竭未显示出有益作用，但SGLT2抑制剂能显著且持续地降低新发和恶化心力衰竭的风险。最近的两项试验表明，这些有利作用在射血分数降低的非糖尿病心力衰竭患者中也存在，从而显著降低了因心力衰竭住院的风险，可能还降低了心血管疾病和全因死亡率。已证明SGLT2抑制剂在包括沙库巴曲/缬沙坦在内的推荐心力衰竭治疗基础上具有益处，对射血分数保留的心力衰竭可能也有益处。在这篇综述中，我们讨论抗糖尿病药物对心力衰竭的影响。
