Masarone Daniele, Pacileo Roberta, Pacileo Giuseppe
Heart Failure Unit, Department of Cardiology, AORN Dei Colli-Monaldi Hospital, Via Leonardo Bianchi 1, 80100, Naples, Italy.
Heart Fail Rev. 2023 May;28(3):657-665. doi: 10.1007/s10741-021-10189-4. Epub 2021 Nov 3.
Type 2 diabetes mellitus and heart failure are closely related, patients with type 2 diabetes mellitus have a higher risk of developing heart failure, and those with heart failure are at increased risk of developing type 2 diabetes. Although no specific randomized clinical trials have been conducted to test the effect of cardiovascular therapies (drugs and/or devices) in diabetic patients with heart failure, a lot of evidence shows that all interventions effective in improving prognosis in patients with heart failure reduced ejection fraction are equally beneficial in patients with and without diabetes. However, the use of disease-modifying drugs in patients with diabetes and heart failure reduced ejection fraction is a clinical challenge due to the increased risk of adverse effects. For example, β-blockers are underutilized in diabetic patients due to the theoretical unfavorable effects on glucose metabolism as well as the use of drugs that interact with the renin-angiotensin system can be challenged in patients with diabetic nephropathy because of the risk of hyperkalemia. This review outlines the current use of disease-modifying drugs in diabetic patients with heart failure reduced ejection fraction. In addition, the role of novel pharmacologic agents as type 2 sodium-glucose co-transporter inhibitors (SGLT2ii) is discussed.
2型糖尿病与心力衰竭密切相关，2型糖尿病患者发生心力衰竭的风险更高，而心力衰竭患者患2型糖尿病的风险也会增加。尽管尚未进行专门的随机临床试验来检验心血管治疗（药物和/或器械）对糖尿病合并心力衰竭患者的疗效，但大量证据表明，所有对射血分数降低的心力衰竭患者改善预后有效的干预措施，对有糖尿病和无糖尿病的患者同样有益。然而，在射血分数降低的糖尿病合并心力衰竭患者中使用改善病情的药物是一项临床挑战，因为不良反应风险增加。例如，β受体阻滞剂在糖尿病患者中使用不足，原因是其对糖代谢存在理论上的不利影响，而且在糖尿病肾病患者中，由于存在高钾血症风险，使用与肾素-血管紧张素系统相互作用的药物可能会受到质疑。本综述概述了目前在射血分数降低的糖尿病合并心力衰竭患者中使用改善病情药物的情况。此外，还讨论了新型药物作为2型钠-葡萄糖协同转运蛋白抑制剂（SGLT2ii）的作用。
