BHF Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK.
Diabetes Obes Metab. 2023 Jul;25 Suppl 3(Suppl 3):26-32. doi: 10.1111/dom.15171. Epub 2023 Jun 19.
Sodium-glucose cotransporter 2 inhibitors (SGLT-2is) were originally developed for the treatment of hyperglycaemia in type 2 diabetes. Because of regulatory requirements to show the safety of this new class of drugs, a large randomized cardiovascular (CV) outcomes trial was completed but this showed that instead of having a neutral effect on heart failure (HF) outcomes, that these drugs could reduce HF outcomes in this population. Subsequent trials with SGLT-2is have shown that HF hospitalizations are reduced by 30% and CV death or HF hospitalization by 21% in patients with type 2 diabetes. These findings have extended to patients with HF with reduced and mildly reduced or preserved ejection fraction in whom further HF hospitalizations are reduced by 28% and CV death or HF hospitalizations reduced by 23%, and that it is becoming a central therapy for the treatment of HF. Moreover, the benefit in patients with HF is observed regardless of the presence or absence of type 2 diabetes. Similarly, in patients with chronic kidney disease and albuminuria, with and without type 2 diabetes, the benefit of SGLT-2is is clearly seen with a 44% reduction in HF hospitalization and 25% reduction in CV death or HF hospitalization. These trials support the use of SGLT-2is in improving HF outcomes in a broad range of patients, from those with type 2 diabetes, chronic kidney disease and those with pre-existing HF regardless of ejection fraction.
钠-葡萄糖共转运蛋白 2 抑制剂（SGLT-2is）最初是为治疗 2 型糖尿病的高血糖而开发的。由于监管要求显示这种新药类的安全性，一项大型随机心血管（CV）结局试验已经完成，但该试验表明，这些药物并没有对心力衰竭（HF）结局产生中性影响，反而可以降低该人群的 HF 结局。随后的 SGLT-2is 试验表明，2 型糖尿病患者的 HF 住院率降低了 30%，CV 死亡或 HF 住院率降低了 21%。这些发现已经扩展到射血分数降低、轻度降低或保留的 HF 患者，这些患者的 HF 住院率降低了 28%，CV 死亡或 HF 住院率降低了 23%，并且它正在成为 HF 治疗的核心疗法。此外，无论是否存在 2 型糖尿病，HF 患者都能观察到获益。同样，在伴有或不伴有 2 型糖尿病的慢性肾脏病和白蛋白尿患者中，SGLT-2is 的获益也很明显，HF 住院率降低 44%，CV 死亡或 HF 住院率降低 25%。这些试验支持在广泛的患者中使用 SGLT-2is 来改善 HF 结局，包括 2 型糖尿病、慢性肾脏病和无论射血分数如何都有预先存在的 HF 的患者。
