Jain Sneha S, Yu Jie, Arnott Clare, Neal Bruce, Perkovic Vlado, Neuen Brendon L, Jardine Meg, Mahaffey Kenneth W
Division of Cardiovascular Medicine, Stanford University, Palo Alto, CA, United States of America.
The George Institute for Global health, UNSW Sydney, Sydney, Australia; Faculty of Medicine, University of New South Wales, Sydney, Sydney, Australia; Department of Cardiology, Peking University Third Hospital, Beijing, China.
Int J Cardiol. 2024 Jan 15;395:131444. doi: 10.1016/j.ijcard.2023.131444. Epub 2023 Oct 14.
Canagliflozin is a sodium-glucose cotransporter 2 inhibitor that has been shown to reduce cardiovascular events in diabetic patients with and without heart failure (HF). Whether the clinical benefits and safety profile of canagliflozin are different in those on a beta blocker and an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (BB + RAASi) is unknown.
We pooled participants with HF at baseline from the CANVAS Program and CREDENCE trial and assessed major adverse cardiovascular events and its components; hospitalization for heart failure (HHF); HHF or CV death; all-cause mortality; a renal composite; and a combined renal and CV composite.
Of 14,543 participants, 2113 had HF at baseline, and 1280 were on BB + RAASi. In those with a history of HF, participants on BB + RAASi therapy were more likely to have coronary atherosclerotic disease (82 vs 72%, p < 0.001), history of myocardial infarction (42 vs 29%, p < 0.001), higher mean body mass index (34 vs 32 kg/m, p < 0.001), and lower mean estimated glomerular filtration rate (67 vs 70 mL/min/1.73 m, p < 0.01). They were also more likely to be on insulin, a statin, antithrombotic agent, and a diuretic (all p < 0.001). In unadjusted analysis and when adjusted for selected baseline factors, there was no heterogeneity in canagliflozin treatment effect except for HHF/CV death in those on baseline BB + RAASi vs. those not on baseline BB + RAASi (P = 0.02).
Canagliflozin mostly improved CV and kidney outcomes in participants with a history of HF irrespective of use of BB + RAASi at baseline, with possible greater benefit on HHF/CV death in participants on BB + RAASi.
卡格列净是一种钠-葡萄糖协同转运蛋白2抑制剂，已被证明可降低伴有或不伴有心力衰竭（HF）的糖尿病患者的心血管事件发生率。卡格列净在同时使用β受体阻滞剂和血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂（BB + RAASi）的患者中的临床益处和安全性是否有所不同尚不清楚。
我们汇总了CANVAS项目和CREDENCE试验中基线时患有HF的参与者，并评估了主要不良心血管事件及其组成部分；因心力衰竭住院（HHF）；HHF或心血管死亡；全因死亡率；肾脏综合指标；以及肾脏和心血管综合指标。
在14543名参与者中，2113人在基线时患有HF，1280人使用BB + RAASi。在有HF病史的参与者中，接受BB + RAASi治疗的参与者更有可能患有冠状动脉粥样硬化疾病（82%对72%，p < 0.001）、心肌梗死病史（42%对29%，p < 0.001）、平均体重指数更高（34对32 kg/m，p < 0.001）以及平均估计肾小球滤过率更低（67对70 mL/min/1.73 m，p < 0.01）。他们也更有可能使用胰岛素、他汀类药物、抗血栓药物和利尿剂（所有p < 0.001）。在未调整分析以及对选定基线因素进行调整后，除了基线时使用BB + RAASi的参与者与未使用BB + RAASi的参与者相比在HHF/心血管死亡方面外，卡格列净治疗效果没有异质性（P = 0.02）。
无论基线时是否使用BB + RAASi，卡格列净大多改善了有HF病史参与者的心血管和肾脏结局，对使用BB + RAASi的参与者在HHF/心血管死亡方面可能有更大益处。
