Georgiou Petros, Shi Wangpan, Serhiyenia Tatsiana, Akram Aqsa, Proute Matthew C, Pradeep Roshini, Kerolos Mina E, Khan Safeera
Department of Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
Cureus. 2021 Oct 4;13(10):e18485. doi: 10.7759/cureus.18485. eCollection 2021 Oct.
Cardiovascular disease (CVD) is the leading cause of mortality worldwide yet, despite advances in treatment, CVD remains an underestimated and undermanaged condition, with an even greater risk in Type 2 Diabetes Mellitus (T2DM). Sodium-Glucose Cotransporter-2 Inhibitors (SGLT-2i) are a promising novel drug class reported to improve Cardiovascular (CV) and renal outcomes in T2DM. Recent large-scale trials have assessed their CV safety with unexpected findings of multiple systemic benefits that could potentially reverse CVD. In this systematic review, we examined ten Randomized Controlled Trials (RCTs) that looked at cardiovascular outcomes in Type 2 diabetics and SGLT-2i. The RCTs were appropriately screened, looking for clear primary or secondary outcomes on CV events, and compared with placebo or other antidiabetic drugs. The RCTs had an average sample population studied of 5,549 participants with a mean follow-up time of 2.66 years. Three of the studies focused on CV parameters and risk factors. The remaining had defined CV composite events, and all consistently observed at least one CV benefit when using SGLT-2i. Our review of SGLT-2i in Type 2 diabetics showed the greatest benefit in reducing Heart Failure (HF) exacerbation and modest lowering of CV complications in high CV risk participants. Overall, there is still uncertainty about the exact mechanisms of SGLT-2i in their CV benefit, and whether they would favor pre-diabetic populations and those at earlier stages of CVD.
心血管疾病（CVD）是全球范围内导致死亡的主要原因。然而，尽管在治疗方面取得了进展，但CVD仍然是一种被低估且管理不足的疾病，在2型糖尿病（T2DM）患者中风险更高。钠-葡萄糖协同转运蛋白2抑制剂（SGLT-2i）是一类有前景的新型药物，据报道可改善T2DM患者的心血管（CV）和肾脏结局。最近的大规模试验评估了它们的CV安全性，结果发现了多种可能逆转CVD的全身性益处，令人意外。在这项系统评价中，我们研究了10项随机对照试验（RCT），这些试验观察了2型糖尿病患者使用SGLT-2i后的心血管结局。对这些RCT进行了适当筛选，寻找关于CV事件的明确主要或次要结局，并与安慰剂或其他抗糖尿病药物进行比较。这些RCT平均研究样本量为5549名参与者，平均随访时间为2.66年。其中三项研究关注CV参数和风险因素。其余研究定义了CV复合事件，并且在使用SGLT-2i时均一致观察到至少一项CV益处。我们对2型糖尿病患者使用SGLT-2i的评价表明，在降低心力衰竭（HF）恶化方面益处最大，在高CV风险参与者中可适度降低CV并发症。总体而言，SGLT-2i产生CV益处的确切机制以及它们是否对糖尿病前期人群和CVD早期阶段的人群有益，目前仍不确定。
