Division of Nephrology, University Health Network, Toronto, ON M5G 2C4, Canada; The Department of Medicine, University of Toronto, Toronto, ON M5G 1X5, Canada.
Division of Cardiology, Women's College Hospital, Toronto, ON M5S 1B2, Canada; The Department of Medicine, University of Toronto, Toronto, ON M5G 1X5, Canada.
Med. 2021 Nov 12;2(11):1203-1230. doi: 10.1016/j.medj.2021.10.004.
Cardiovascular and renal outcome trials (CVOTs) for glucagon-like-peptide-1 receptor agonists (GLP1RA) and sodium-glucose cotransporter 2 inhibitors (SGLT2i) highlight new options for people with and without type 2 diabetes (T2D). Drugs within these classes reduce rates of major adverse cardiovascular events (MACE), with SGLT2i simultaneously attenuating decline in kidney function. SGLT2i reduce rates of heart failure in people with and without T2D, whereas GLP1RA lower rates of myocardial infarction and stroke in people with T2D with or without preexisting cardiovascular disease. Mechanistically, SGLT2 and the GLP-1 receptor are expressed at low levels in the heart, and within some blood vessels and immune cells, implying indirect mechanisms of action for the preservation of ventricular function, and reduction of atherosclerosis. SGLT2i likely preserve renal function through the alteration of glomerular hemodynamics. These two drug classes enable organ protection and reduced mortality in people with T2D and represent promising therapies for some people without T2D.
胰高血糖素样肽-1 受体激动剂 (GLP1RA) 和钠-葡萄糖共转运蛋白 2 抑制剂 (SGLT2i) 的心血管和肾脏结局试验 (CVOTs) 为有和没有 2 型糖尿病 (T2D) 的人提供了新的选择。这些类别中的药物降低了主要不良心血管事件 (MACE) 的发生率，同时 SGLT2i 减缓了肾功能下降的速度。SGLT2i 降低了有和没有 T2D 的人心力衰竭的发生率，而 GLP1RA 降低了有或没有先前心血管疾病的 T2D 患者的心肌梗死和中风的发生率。从机制上讲，SGLT2 和 GLP-1 受体在心脏中低水平表达，并且在一些血管和免疫细胞中表达，这意味着对心室功能的保护和动脉粥样硬化减少的间接作用机制。SGLT2i 可能通过改变肾小球血流动力学来保护肾功能。这两种药物类别可在 T2D 患者中实现器官保护和降低死亡率，并为一些没有 T2D 的患者提供有前途的治疗方法。
