Naito Ayami, Nagatomo Yuji, Kawai Akane, Yukino-Iwashita Midori, Nakazawa Ryota, Taruoka Akira, Takefuji Asako, Yasuda Risako, Toya Takumi, Ikegami Yukinori, Masaki Nobuyuki, Ido Yasuo, Adachi Takeshi
Department of Cardiology, National Defense Medical College, Tokorozawa 359-8513, Japan.
Department of Intensive Care, National Defense Medical College, Tokorozawa 359-8513, Japan.
J Pers Med. 2024 Jan 26;14(2):141. doi: 10.3390/jpm14020141.
Sodium-glucose cotransporter-2 inhibitors (SGLT-2is) show cardiovascular protective effects, regardless of the patient's history of diabetes mellitus (DM). SGLT2is suppressed cardiovascular adverse events in patients with type 2 DM, and furthermore, SGLT-2is reduced the risk of worsening heart failure (HF) events or cardiovascular death in patients with HF. Along with these research findings, SGLT-2is are recommended for patients with HF in the latest guidelines. Despite these benefits, the concern surrounding the increasing risk of body weight loss and other adverse events has not yet been resolved, especially for patients with sarcopenia or frailty. The DAPA-HF and DELIVER trials consistently showed the efficacy and safety of SGLT-2i for HF patients with frailty. However, the Rockwood frailty index that derived from a cumulative deficit model was employed for frailty assessment in these trials, which might not be suitable for the evaluation of physical frailty or sarcopenia alone. There is no fixed consensus on which evaluation tool to use or its cutoff value for the diagnosis and assessment of frailty in HF patients, or which patients can receive SGLT-2i safely. In this review, we summarize the methodology of frailty assessment and discuss the efficacy and safety of SGLT-2i for HF patients with sarcopenia or frailty.
钠-葡萄糖协同转运蛋白2抑制剂（SGLT-2i）显示出心血管保护作用，无论患者有无糖尿病（DM）病史。SGLT-2i可抑制2型糖尿病患者的心血管不良事件，此外，SGLT-2i还可降低心力衰竭（HF）患者发生心力衰竭恶化事件或心血管死亡的风险。基于这些研究结果，最新指南推荐SGLT-2i用于HF患者。尽管有这些益处，但体重减轻及其他不良事件风险增加的问题仍未得到解决，尤其是对于肌肉减少症或身体虚弱的患者。DAPA-HF和DELIVER试验一致显示了SGLT-2i对身体虚弱的HF患者的疗效和安全性。然而，这些试验中使用的基于累积缺陷模型得出的Rockwood虚弱指数用于虚弱评估，可能并不适合单独评估身体虚弱或肌肉减少症。对于HF患者虚弱的诊断和评估使用何种评估工具及其临界值，或者哪些患者可以安全使用SGLT-2i，目前尚无固定的共识。在本综述中，我们总结了虚弱评估方法，并讨论了SGLT-2i对合并肌肉减少症或身体虚弱的HF患者的疗效和安全性。
