钠-葡萄糖共转运蛋白 2 抑制剂在心力衰竭预防和治疗中的临床应用：超越 2 型糖尿病。一篇叙述性综述。

Use of Sodium-Glucose Cotransporter-2 Inhibitors in Clinical Practice for Heart Failure Prevention and Treatment: Beyond Type 2 Diabetes. A Narrative Review.

机构信息

Division of Cardiology, Department of Medicine, NYU Langone Medical Center, 530 First Avenue, Skirball 9N, New York, NY, 10016, USA.

出版信息

Adv Ther. 2022 Feb;39(2):845-861. doi: 10.1007/s12325-021-01989-z. Epub 2021 Dec 9.

DOI:10.1007/s12325-021-01989-z

PMID:34881413

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8866261/

Abstract

Despite the availability of established treatments, heart failure (HF) is associated with a poor prognosis and its management is suboptimal, highlighting the need for new options for treatment and prevention. Patients with type 2 diabetes (T2D) often experience cardiovascular (CV) complications, with HF being one of the most frequent. Consequently, several CV outcome trials have focused on glucose-lowering therapies and their impact on CV outcomes. An established treatment for T2D, sodium-glucose cotransporter-2 inhibitors (SGLT-2is; canagliflozin, dapagliflozin, empagliflozin, and ertugliflozin) have demonstrated beneficial effects on CV outcomes in long-term studies of patients with T2D with established CV disease and/or a broad range of CV risk factors. Recent studies have extended these findings to patients with HF, with and without T2D, finding that SGLT-2is (particularly dapagliflozin and empagliflozin) are effective therapeutic interventions for the treatment and prevention of HF. This narrative review article discusses the use of SGLT-2is in the treatment and prevention of HF in patients with and without T2D. Dapagliflozin was the first SGLT-2i to receive US Food and Drug Administration (FDA) approval for treatment of HF, to reduce the risk of CV death and hospitalization for HF in adults with HF with reduced ejection fraction (HFrEF) with and without T2D. Recently, the FDA also approved empagliflozin for this indication. Given the new HFrEF indications for dapagliflozin and empagliflozin, and the likelihood of similar approvals for other SGLT-2is, cardiology guidelines are beginning to integrate SGLT-2is into a standard-of-care treatment regimen for patients with HFrEF. The utility of SGLT-2is in HF with preserved EF (HFpEF) shows promise based on data from the EMPEROR-Preserved study of empagliflozin in patients with HFpEF. Further clinical trial evidence may lead to more widespread use and further integration of SGLT-2is into standard-of-care regimens for the treatment and management of HF in patients with and without T2D.

摘要

尽管已有既定的治疗方法，但心力衰竭（HF）仍与预后不良相关，其治疗效果并不理想，这凸显了我们需要新的治疗和预防选择。2 型糖尿病（T2D）患者常发生心血管（CV）并发症，HF 是其中最常见的并发症之一。因此，多项 CV 结局试验都集中在降糖治疗及其对 CV 结局的影响上。钠-葡萄糖共转运蛋白 2 抑制剂（SGLT-2is；卡格列净、达格列净、恩格列净和埃格列净）是 T2D 的既定治疗方法，其在 T2D 合并已确诊的 CV 疾病和/或广泛 CV 危险因素患者的长期研究中显示出对 CV 结局的有益影响。最近的研究将这些发现扩展到合并或不合并 T2D 的 HF 患者，发现 SGLT-2is（尤其是达格列净和恩格列净）是治疗和预防 HF 的有效治疗干预措施。本文综述了 SGLT-2is 在合并或不合并 T2D 的 HF 患者中的治疗和预防作用。达格列净是首个获得美国食品药品监督管理局（FDA）批准用于 HF 治疗的 SGLT-2i，可降低伴有或不伴有 T2D 的射血分数降低的 HF（HFrEF）成人因 HF 住院或死亡的风险。最近，FDA 还批准恩格列净用于该适应证。鉴于达格列净和恩格列净的新的 HFrEF 适应证，以及其他 SGLT-2is 类似适应证获批的可能性，心脏病学指南开始将 SGLT-2is 纳入 HFrEF 患者的标准治疗方案。基于恩格列净在 HFpEF 患者中的 EMPEROR-Preserved 研究数据，SGLT-2is 在射血分数保留的 HF（HFpEF）中的应用显示出前景。进一步的临床试验证据可能会导致更广泛的应用，并进一步将 SGLT-2is 纳入 T2D 合并或不合并 HF 患者的标准治疗方案中。