Michaud Liana, Seplowe Matthew, Meir Juliet, Aronow Wilbert S
Department of Medicine, Westchester Medical Center, Valhalla, NY, USA.
Department of Cardiology, Westchester Medical Center, Valhalla, NY, USA.
Expert Opin Drug Saf. 2023 Feb;22(2):119-124. doi: 10.1080/14740338.2023.2188190. Epub 2023 Mar 7.
There are three major drug classes discussed in this review: dipeptidyl dipeptidase-4 (DPP4) inhibitors, glucagon-like peptide-1 receptor agonists (GLP-1 RAS), and sodium-glucose cotransporter-2 (SGLT2) inhibitors. A literature review of the landmark cardiovascular outcome trials from 2008 to 2021 was conducted.
The cumulative data shown in this review suggest that in patients with Type 2 Diabetes (T2D), SGLT2 inhibitors and GLP-1 RAS may reduce cardiovascular (CV) risk. Specifically, in the heart failure (HF) population, SGLT2 inhibitors have shown a reduction in hospitalizations in some randomized controlled trials (RCTs). DPP4 inhibitors have not shown a similar reduction in CV risk and even exhibited an increase in hospitalizations for HF in one RCT. It is important to note that the DPP4 inhibitors did not demonstrate an increase in major CV events, with the exception of the increase in HF hospitalizations in the SAVOR TIMI 53 trial.
Future avenues of research to explore include the use of novel antidiabetic agents to reduce post-myocardial infarction (MI) CV risk and arrhythmias independent of their use as diabetic agents.
本综述讨论了三大类药物：二肽基肽酶-4（DPP4）抑制剂、胰高血糖素样肽-1受体激动剂（GLP-1 RAS）和钠-葡萄糖协同转运蛋白-2（SGLT2）抑制剂。对2008年至2021年具有里程碑意义的心血管结局试验进行了文献综述。
本综述中所示的累积数据表明，在2型糖尿病（T2D）患者中，SGLT2抑制剂和GLP-1 RAS可能会降低心血管（CV）风险。具体而言，在心力衰竭（HF）人群中，SGLT2抑制剂在一些随机对照试验（RCT）中显示住院率有所降低。DPP4抑制剂未显示出类似的CV风险降低，甚至在一项RCT中显示HF住院率有所增加。需要注意的是，除了SAVOR TIMI 53试验中HF住院率增加外，DPP4抑制剂并未显示主要CV事件增加。
未来的研究方向包括使用新型抗糖尿病药物来降低心肌梗死（MI）后CV风险和心律失常，而不依赖于它们作为糖尿病药物的用途。
