Atherosclerosis and Vascular Biology Laboratory (Atherolab), Cardiology Department, State University of Campinas (Unicamp), Campinas, SP, Brazil.
Directory of Clinical Research and Innovation, Institute for Strategic Management in Healthcare (IGESDF), Brasília, DF, Brazil.
J Clin Endocrinol Metab. 2021 Sep 27;106(10):3060-3067. doi: 10.1210/clinem/dgab428.
Sodium glucose co-transporter 2 inhibitors (SGLT2is) prevent hospitalization resulting from heart failure (HHF). However, patients with type 2 diabetes mellitus use multiple antihyperglycemic drugs to achieve glycosylated hemoglobin (HbA1c) targets. In these drug combinations, the risk of HHF is unpredictable and so is the parallel effect of glucose-lowering.
To examine the impact of antihyperglycemic drugs and their association on HHF.
Forty randomized controlled trials (RCTs) reporting HHF.
Published RCTs were the data source.
Incidence rates of HHF.
Random additive-effects network meta-analysis showed that metformin (P = 0.55), sulfonylureas (P = 0.51), glucagon-like peptide-1 receptor-agonist (P = 0.16), and dipeptidyl peptidase 4 inhibitors (DPP4is; P = 0.54) were neutral on the risk of HHF. SGLT2is and SGLT2is + DPP4is reduced the risk of HHF with a hazard ratio (HR) of 0.68 (95% CI, 0.60-0.76; P < 0.0001) and 0.70 (95% CI, 0.60-0.81; P < 0.0001), respectively. Increased risk of HHF was associated with thiazolidinediones (TZDs) as monotherapy or in combination with DPP4is (HR: 1.45; 95% CI, 1.18-1.78; P = 0.0004) and 1.49 (95% CI, 1.18-1.88; P = 0.0008), respectively. Regardless of the therapy, a 1% reduction in HbA1c reduced the risk of HHF by 31.3% (95% CI, 9-48; P = 0.009).
There are no data to verify drug combinations available for clinical use and to discriminate the effect of drugs within each of the therapeutic classes.
The risk of HHF is reduced by SGLT2is as monotherapy or in combination with DPP4is and increased by TZDs as monotherapy or in combination. Glucose-lowering provides an additive effect of reducing HHF.
钠-葡萄糖共转运蛋白 2 抑制剂(SGLT2is)可预防心力衰竭(HHF)导致的住院。然而,2 型糖尿病患者使用多种抗高血糖药物来达到糖化血红蛋白(HbA1c)目标。在这些药物组合中,HHF 的风险是不可预测的,降糖效果也是如此。
研究抗高血糖药物及其联合应用对 HHF 的影响。
40 项报告 HHF 的随机对照试验(RCT)。
已发表的 RCT 是数据来源。
HHF 的发生率。
随机附加效应网络荟萃分析显示,二甲双胍(P=0.55)、磺酰脲类(P=0.51)、胰高血糖素样肽-1 受体激动剂(P=0.16)和二肽基肽酶 4 抑制剂(DPP4is;P=0.54)对 HHF 的风险无影响。SGLT2is 和 SGLT2is+DPP4is 降低 HHF 风险的危险比(HR)分别为 0.68(95%CI,0.60-0.76;P<0.0001)和 0.70(95%CI,0.60-0.81;P<0.0001)。HHF 风险增加与噻唑烷二酮(TZDs)单药或与 DPP4is 联合治疗相关(HR:1.45;95%CI,1.18-1.78;P=0.0004)和 1.49(95%CI,1.18-1.88;P=0.0008)。无论治疗方法如何,HbA1c 降低 1%,HHF 风险降低 31.3%(95%CI,9-48;P=0.009)。
没有数据可以验证临床可用的药物组合,并区分每种治疗类别中药物的作用。
SGLT2is 单药或与 DPP4is 联合治疗可降低 HHF 的风险,TZDs 单药或与 DPP4is 联合治疗可增加 HHF 的风险。降糖作用具有降低 HHF 的附加作用。