钠-葡萄糖协同转运蛋白2抑制剂降低2型糖尿病患者新发中风风险：一项基于人群的队列研究。
Sodium-glucose co-transporter-2 inhibitors reduce the risk of new-onset stroke in patients with type 2 diabetes: A population-based cohort study.
作者信息
Lin Tsung-Kun, Chen Yong-Hsin, Huang Jing-Yang, Liao Pei-Lun, Chen Mei-Chun, Pan Lung-Fa, Jong Gwo-Ping
机构信息
Department of Pharmacy, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan.
School of Pharmacy, National Defense Medical Center, Taipei City, Taiwan.
出版信息
Front Cardiovasc Med. 2022 Aug 9;9:966708. doi: 10.3389/fcvm.2022.966708. eCollection 2022.
BACKGROUND
Epidemiological evidence suggests the association of diabetes with an increased risk of stroke. Clinical studies have investigated the effects of sodium-glucose co-transporter-2 (SGLT2) inhibitors on new-onset stroke (NOS), but the results are inconsistent.
OBJECTIVES
To determine the association between the use of SGLT2 inhibitors and NOS in patients with type 2 diabetes mellitus (DM).
METHODS
We conducted a retrospective longitudinal cohort study based on the Taiwan Health Insurance Review and Assessment Service database (2016-2019). The primary outcome of the assessment was the risk of incident stroke by estimating hazard ratios (HRs) and 95% confidence intervals (CIs). Multiple Cox regression was applied to estimate the adjusted HR of NOS. Subgroup analysis was also conducted.
RESULTS
Among the 232,101 eligible patients with type 2 DM aged ≥ 20 years, SGLT2-inhibitor users were compared with non-SGLT2-inhibitor users based on age, sex, and the duration of type 2 DM matching at a ratio of 1:2. The event rate per 10 000 person-months was 9.20 (95% CI 8.95 to 9.45) for SGLT2-inhibitor users and 10.5(10.3-10.6) for non-SGLT2-inhibitor users. There was a decreased risk of NOS for SGLT2-inhibitor users (adjusted HR 0.85, 95% CI 0.82-0.88) compared with non-SGLT2-inhibitor users. Results for the propensity score-matched analyses showed similar results (adjusted HR 0.87, 95% CI 0.84-0.91 for both SGLT2-inhibitor users and non-SGLT2-inhibitor users).
CONCLUSION
The risk of developing NOS was lower in patients with SGLT2-inhibitor users than in non-SGLT2-inhibitor users. The decreased risk of NOS in patients with type 2 DM was greater among patients with concurrent use of statins, biguanides, thiazolidinediones, and glucagon-like peptide-1 receptor agonists. We, therefore, suggest that the long-term use of SGLT2 inhibitors may help reduce the incidence of NOS in patients with type 2 DM.
背景
流行病学证据表明糖尿病与中风风险增加有关。临床研究已调查了钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂对新发中风（NOS）的影响，但结果并不一致。
目的
确定2型糖尿病（DM）患者中使用SGLT2抑制剂与NOS之间的关联。
方法
我们基于台湾健康保险审查和评估服务数据库（2016 - 2019年）进行了一项回顾性纵向队列研究。评估的主要结局是通过估计风险比（HRs）和95%置信区间（CIs）来确定中风发生风险。应用多重Cox回归来估计NOS的调整后HR。还进行了亚组分析。
结果
在232101名年龄≥20岁的符合条件的2型DM患者中，将使用SGLT2抑制剂的患者与未使用SGLT2抑制剂的患者按年龄、性别和2型DM病程以1:2的比例进行匹配比较。SGLT2抑制剂使用者每10000人月的事件发生率为9.20（95%CI 8.95至9.45），未使用SGLT2抑制剂的患者为10.5（10.3 - 10.6）。与未使用SGLT2抑制剂的患者相比，使用SGLT2抑制剂的患者发生NOS的风险降低（调整后HR 0.85，95%CI 0.82 - 0.88）。倾向评分匹配分析的结果显示了相似的结果（SGLT2抑制剂使用者和未使用SGLT2抑制剂的患者调整后HR均为0.87，95%CI 0.84 - 0.91）。
结论
使用SGLT2抑制剂的患者发生NOS的风险低于未使用SGLT2抑制剂的患者。在同时使用他汀类药物、双胍类药物、噻唑烷二酮类药物和胰高血糖素样肽-1受体激动剂的2型DM患者中，发生NOS风险降低的幅度更大。因此，我们建议长期使用SGLT2抑制剂可能有助于降低2型DM患者中NOS的发生率。
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