Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy.
Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy.
Metabolism. 2022 Feb;127:154937. doi: 10.1016/j.metabol.2021.154937. Epub 2021 Nov 19.
Despite remarkable advances in diabetes care, patients with type 2 diabetes are still burdened by higher morbidity and mortality than non-diabetic individuals. Atherosclerotic cardiovascular disease, heart failure, and chronic kidney disease represent the most relevant causes of morbidity and mortality and sustain each other in a vicious circle. Cardiovascular diseases are the main cause of death in patients with chronic kidney disease, and, in turn, chronic kidney disease is a significant contributor to the risk of major cardiovascular events and hospitalization for heart failure. Cardiovascular outcome trials with SGLT-2 inhibitors in type 2 diabetes yielded unprecedented results on prevention of worsening heart failure and renal disease progression and mortality, further confirmed by randomized controlled trials in patients with baseline heart failure and chronic kidney disease, with or without diabetes, and observations from the real-world setting. However, the evidence regarding SGLT-2 inhibitors benefit on atherosclerotic cardiovascular events is conflicting. Hence, SGLT-2 inhibitors represent a remarkably valuable weapon in diabetes management, to be used in the context of a multi-targeted treatment strategy to address the many issues of this multifaceted disease.
尽管糖尿病治疗取得了显著进展,但 2 型糖尿病患者的发病率和死亡率仍高于非糖尿病患者。动脉粥样硬化性心血管疾病、心力衰竭和慢性肾脏病是发病率和死亡率的主要原因,并在恶性循环中相互维持。心血管疾病是慢性肾脏病患者死亡的主要原因,而慢性肾脏病则是发生主要心血管事件和心力衰竭住院的重要危险因素。在 2 型糖尿病患者中进行的 SGLT-2 抑制剂心血管结局试验在预防心力衰竭恶化和肾脏疾病进展及死亡率方面取得了前所未有的结果,在基线时患有心力衰竭和慢性肾脏病的患者中进行的随机对照试验以及真实世界的观察结果进一步证实了这一点,无论是否合并糖尿病。然而,关于 SGLT-2 抑制剂对动脉粥样硬化性心血管事件的益处的证据存在争议。因此,SGLT-2 抑制剂是糖尿病管理中非常有价值的武器,可在多目标治疗策略的背景下使用,以解决这种多方面疾病的许多问题。
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