Koniari Ioanna, Velissaris Dimitrios, Kounis Nicholas G, Koufou Eleni, Artopoulou Eleni, de Gregorio Cesare, Mplani Virginia, Paraskevas Themistoklis, Tsigkas Grigorios, Hung Ming-Yow, Plotas Panagiotis, Lambadiari Vaia, Ikonomidis Ignatios
Department of Cardiology, University Hospital of South Manchester NHS Foundation Trust, Manchester M23 9LT, UK.
Department of Internal Medicine, University Hospital of Patras, 26500 Patras, Greece.
J Clin Med. 2022 Aug 9;11(16):4660. doi: 10.3390/jcm11164660.
Diabetes mellitus (DM) and heart failure (HF) are two chronic disorders that affect millions worldwide. Hyperglycemia can induce excessive generation of highly reactive free radicals that promote oxidative stress and further exacerbate diabetes progression and its complications. Vascular dysfunction and damage to cellular proteins, membrane lipids and nucleic acids can stem from overproduction and/or insufficient removal of free radicals. The aim of this article is to review the literature regarding the use of antidiabetic drugs and their role in glycemic control in patients with heart failure and oxidative stress. Metformin exerts a minor benefit to these patients. Thiazolidinediones are not recommended in diabetic patients, as they increase the risk of HF. There is a lack of robust evidence on the use of meglinitides and acarbose. Insulin and dipeptidyl peptidase-4 (DPP-4) inhibitors may have a neutral cardiovascular effect on diabetic patients. The majority of current research focuses on sodium glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide 1 (GLP-1) receptor agonists. SGLT2 inhibitors induce positive cardiovascular effects in diabetic patients, leading to a reduction in cardiovascular mortality and HF hospitalization. GLP-1 receptor agonists may also be used in HF patients, but in the case of chronic kidney disease, SLGT2 inhibitors should be preferred.
糖尿病（DM）和心力衰竭（HF）是影响全球数百万人的两种慢性疾病。高血糖会诱导高反应性自由基的过度生成，从而促进氧化应激，并进一步加剧糖尿病的进展及其并发症。自由基的过度产生和/或清除不足可导致血管功能障碍以及细胞蛋白质、膜脂质和核酸的损伤。本文旨在综述有关抗糖尿病药物的使用及其在心力衰竭和氧化应激患者血糖控制中的作用的文献。二甲双胍对这些患者有轻微益处。噻唑烷二酮类药物不推荐用于糖尿病患者，因为它们会增加心力衰竭的风险。关于瑞格列奈和阿卡波糖的使用，缺乏有力证据。胰岛素和二肽基肽酶 -4（DPP-4）抑制剂可能对糖尿病患者有中性心血管作用。目前的大多数研究集中在钠 - 葡萄糖协同转运蛋白2（SGLT2）抑制剂和胰高血糖素样肽1（GLP-1）受体激动剂上。SGLT2抑制剂在糖尿病患者中产生积极的心血管作用，导致心血管死亡率降低和心力衰竭住院率降低。GLP-1受体激动剂也可用于心力衰竭患者，但在慢性肾病的情况下，应优先选择SGLT2抑制剂。
