TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Suite 7022, Boston, MA, 02115, USA.
University of Texas Southwestern Medical Center, Dallas, TX, USA.
Curr Diab Rep. 2021 Nov 6;21(11):45. doi: 10.1007/s11892-021-01417-0.
The cardiovascular benefits of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1 RA) have increased the focus of type 2 diabetes mellitus (T2DM) care on comprehensive cardiovascular risk reduction. Herein, we review the results of the cardiovascular outcomes trials of SGLT2i and GLP-1 RA, discuss the concepts of relative vs. absolute risk reduction in the context of these trials, and highlight the importance of individualized risk assessment when applying trial results to clinical practice.
To enable personalized treatment approaches, multiple clinical risk scores have been developed to assess risk of atherosclerotic cardiovascular disease (ASCVD) outcomes and hospitalization for heart failure (HHF) in patients with T2DM. In addition, circulating biomarkers of myocardial injury (cardiac troponin) and hemodynamic stress (natriuretic peptides) have been shown to further refine risk prediction of these clinically important cardiovascular complications. When making decisions about whether to initiate SGLT2i and GLP-1 RA, clinicians should consider the anticipated relative and absolute treatment benefits from these antihyperglycemic therapies. Clinicians can use available clinical and biomarker-based risk tools when counseling patients about their individual cardiovascular risk profiles and when estimating absolute treatment benefits from SGLT2i and GLP-1 RA.
钠-葡萄糖共转运蛋白 2 抑制剂（SGLT2i）和胰高血糖素样肽 1 受体激动剂（GLP-1RA）的心血管益处增加了 2 型糖尿病（T2DM）管理对全面降低心血管风险的关注。在此，我们回顾了 SGLT2i 和 GLP-1RA 的心血管结局试验结果，讨论了这些试验中相对风险降低和绝对风险降低的概念，并强调了在将试验结果应用于临床实践时进行个体化风险评估的重要性。
为了实现个性化治疗方法，已经开发了多种临床风险评分来评估 T2DM 患者发生动脉粥样硬化性心血管疾病（ASCVD）结局和心力衰竭（HHF）住院的风险。此外，心肌损伤（心肌肌钙蛋白）和血流动力学应激（利钠肽）的循环生物标志物也被证明可以进一步细化这些临床重要心血管并发症的风险预测。在决定是否启动 SGLT2i 和 GLP-1RA 时，临床医生应考虑这些抗高血糖治疗的预期相对和绝对治疗获益。临床医生可以在为患者提供个体心血管风险概况咨询和估计 SGLT2i 和 GLP-1RA 的绝对治疗获益时使用现有的临床和基于生物标志物的风险工具。
