GLP-1 受体激动剂- SGLT-2 抑制剂联合治疗与急性心肌梗死后心血管事件：2 型糖尿病患者的观察性研究。

GLP-1 receptor agonists-SGLT-2 inhibitors combination therapy and cardiovascular events after acute myocardial infarction: an observational study in patients with type 2 diabetes.

机构信息

Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia, 2, 80138, Naples, Italy.

IRCCS MultiMedica, Via Fantoli 16/15, 20138, Milan, Italy.

出版信息

Cardiovasc Diabetol. 2024 Jan 6;23(1):10. doi: 10.1186/s12933-023-02118-6.

DOI:10.1186/s12933-023-02118-6

PMID:38184582

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10771648/

Abstract

BACKGROUND

Few studies explored the effect of the combination of glucose sodium-cotransporter-2 inhibitors (SGLT-2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) on the incidence of cardiovascular events in patients with type 2 diabetes (T2D) and acute myocardial infarction (AMI).

METHODS

We recruited patients with T2D and AMI undergoing percutaneous coronary intervention, treated with either SGLT-2i or GLP-1RA for at least 3 months before hospitalization. Subjects with HbA1c < 7% at admission were considered in good glycemic control and maintained the same glucose-lowering regimen, while those with poor glycemic control (HbA1c ≥ 7%), at admission or during follow-up, were prescribed either a SGLT-2i or a GLP-1RA to obtain a SGLT-2i/GLP-1RA combination therapy. The primary outcome was the incidence of major adverse cardiovascular events (MACE) defined as cardiovascular death, re-acute coronary syndrome, and heart failure related to AMI during a 2-year follow-up. After 3 months, the myocardial salvage index (MSI) was assessed by single-photon emission computed tomography.

FINDINGS

Of the 537 subjects screened, 443 completed the follow-up. Of these, 99 were treated with SGLT-2i, 130 with GLP-1RA, and 214 with their combination. The incidence of MACE was lower in the combination therapy group compared with both SGLT-2i and GLP-1RA treated patients, as assessed by multivariable Cox regression analysis adjusted for cardiovascular risk factors (HR = 0.154, 95% CI 0.038-0.622, P = 0.009 vs GLP-1RA and HR = 0.170, 95% CI 0.046-0.633, P = 0.008 vs SGLT-2i). The MSI and the proportion of patients with MSI > 50% was higher in the SGLT-2i/GLP-1RA group compared with both SGLT-2i and GLP-1RA groups.

INTERPRETATION

The combination of SGLT-2i and GLP-1RA is associated with a reduced incidence of cardiovascular events in patients with T2D and AMI compared with either drug used alone, with a significant effect also on peri-infarcted myocardial rescue in patients without a second event. Trial registraition ClinicalTrials.gov ID: NCT06017544.

摘要

背景

很少有研究探讨钠-葡萄糖共转运蛋白 2 抑制剂（SGLT-2i）和胰高血糖素样肽-1 受体激动剂（GLP-1RA）联合治疗对 2 型糖尿病（T2D）和急性心肌梗死（AMI）患者心血管事件发生率的影响。

方法

我们招募了接受经皮冠状动脉介入治疗的 T2D 和 AMI 患者，这些患者在入院前至少接受了 3 个月的 SGLT-2i 或 GLP-1RA 治疗。入院时糖化血红蛋白（HbA1c）<7%的患者被认为血糖控制良好，并维持相同的降糖方案，而入院或随访期间 HbA1c≥7%的患者则被开处方 SGLT-2i 或 GLP-1RA，以获得 SGLT-2i/GLP-1RA 联合治疗。主要结局是 2 年随访期间心血管死亡、再发急性冠状动脉综合征和与 AMI 相关的心衰组成的主要不良心血管事件（MACE）的发生率。3 个月后，通过单光子发射计算机断层扫描评估心肌挽救指数（MSI）。

结果

在筛选的 537 名患者中，有 443 名完成了随访。其中，99 名患者接受 SGLT-2i 治疗，130 名患者接受 GLP-1RA 治疗，214 名患者接受 SGLT-2i/GLP-1RA 联合治疗。多变量 Cox 回归分析调整心血管危险因素后，联合治疗组的 MACE 发生率低于 SGLT-2i 和 GLP-1RA 治疗组（HR=0.154，95%CI 0.038-0.622，P=0.009 与 GLP-1RA 相比；HR=0.170，95%CI 0.046-0.633，P=0.008 与 SGLT-2i 相比）。与 SGLT-2i 和 GLP-1RA 组相比，SGLT-2i/GLP-1RA 组的 MSI 更高，且 MSI>50%的患者比例也更高。