Keller Daria M, Ahmed Natasha, Tariq Hamza, Walgamage Malsha, Walgamage Thilini, Mohammed Azad, Chou Jadzia Tin-Tsen, Kałużna-Oleksy Marta, Lesiak Maciej, Straburzyńska-Migaj Ewa
Ist Department of Cardiology, Poznan University of Medical Sciences, 61-848 Poznan, Poland.
Cardiology Department, Lancashire Teaching Hospitals NHS Foundation Trust, Preston PR2 9HT, UK.
J Clin Med. 2022 Mar 8;11(6):1470. doi: 10.3390/jcm11061470.
The incidence of both diabetes mellitus type 2 and heart failure is rapidly growing, and the diseases often coexist. Sodium-glucose co-transporter 2 inhibitors (SGLT2i) are a new antidiabetic drug class that mediates epithelial glucose transport at the renal proximal tubules, inhibiting glucose absorption-resulting in glycosuria-and therefore improving glycemic control. Recent trials have proven that SGLT2i also improve cardiovascular and renal outcomes, including reduced cardiovascular mortality and fewer hospitalizations for heart failure. Reduced preload and afterload, improved vascular function, and changes in tissue sodium and calcium handling may also play a role. The expected paradigm shift in treatment strategies was reflected in the most recent 2021 guidelines published by the European Society of Cardiology, recommending dapagliflozin and empagliflozin as first-line treatment for heart failure patients with reduced ejection fraction. Moreover, the recent results of the EMPEROR-Preserved trial regarding empagliflozin give us hope that there is finally an effective treatment for patients with heart failure with preserved ejection fraction. This review aims to assess the efficacy and safety of these new anti-glycemic oral agents in the management of diabetic and heart failure patients.
2型糖尿病和心力衰竭的发病率都在迅速上升,且这两种疾病常常并存。钠-葡萄糖协同转运蛋白2抑制剂(SGLT2i)是一类新型抗糖尿病药物,可介导肾近端小管的上皮葡萄糖转运,抑制葡萄糖吸收,导致糖尿,从而改善血糖控制。近期试验已证实,SGLT2i还可改善心血管和肾脏结局,包括降低心血管死亡率以及减少因心力衰竭住院的次数。前负荷和后负荷降低、血管功能改善以及组织钠和钙处理的变化也可能起作用。治疗策略的预期范式转变反映在欧洲心脏病学会发布的最新2021年指南中,该指南推荐达格列净和恩格列净作为射血分数降低的心力衰竭患者的一线治疗药物。此外,恩格列净的EMPEROR-Preserved试验的最新结果让我们看到希望,即对于射血分数保留的心力衰竭患者终于有了一种有效的治疗方法。本综述旨在评估这些新型口服降糖药物在糖尿病和心力衰竭患者管理中的疗效和安全性。
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