Cardiology Unit, Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden.
Department of Research and Development, Region Kronoberg, Växjö, Sweden.
Cardiovasc Diabetol. 2024 Aug 7;23(1):290. doi: 10.1186/s12933-024-02365-1.
To explore trends in prognosis and use of glucose-lowering drugs (GLD) in patients with diabetes and coronary artery disease (CAD).
All patients with diabetes and CAD undergoing a coronary angiography between 2010 and 2021 according to the Swedish Angiography and Angioplasty Registry were included. Information on GLD (dispended 6 months before or after coronary angiography) was collected from the Swedish Prescribed Drug Registry. Data on major cardiovascular events (MACE; mortality, myocardial infarction, stroke, heart failure) through December 2021 were obtained from national registries. Cox proportional survival analysis was used to assess outcomes where cardioprotective GLD (any of Sodium Glucose Lowering Transport 2 receptor inhibitors [SGLT2i] and Glucagon Like Peptide Receptor Agonists [GLP-1 RA]) served as a reference.
Among all patients (n = 38,671), 31% had stable CAD, and 69% suffered an acute myocardial infarction. Mean age was 69 years, 67% were male, and 81% were on GLD. The use of cardioprotective GLD increased rapidly in recent years (2016-2021; 7-47%) and was more common in younger patients (66 vs. 68 years) and men (72.9% vs. 67.1%) than other GLD. Furthermore, compared with other GLD, the use of cardioprotective GLD was more common in patients with a less frequent history of heart failure (5.0% vs. 6.8%), myocardial infarction (7.7% vs. 10.5%) and chronic kidney disease (3.7% vs. 5.2%). The adjusted hazard ratio (HR) (95% CI) for MACE was greater in patients on other GLD than in those on cardioprotective GLD (1.10; 1.03-1.17, p = 0.004). Trend analyses for the years 2010-2019 revealed improved one-year MACE in patients with diabetes and CAD (year 2019 vs. 2010; 0.90; 0.81-1.00, p = 0.045), while 1-year mortality was unchanged.
The prescription pattern of diabetes medication is changing quickly in patients with diabetes and CAD; however, there are worrying signals of inefficient use prioritizing cardioprotective GLD to younger and healthier individuals at lower cardiovascular risk. Despite this, there are improving trends in 1-year morbidity.
探讨糖尿病合并冠状动脉疾病（CAD）患者的预后和降糖药物（GLD）使用趋势。
纳入 2010 年至 2021 年期间根据瑞典血管造影和血管成形术登记处进行冠状动脉造影的所有糖尿病合并 CAD 患者。从瑞典处方药物登记处收集 GLD（冠状动脉造影前或后 6 个月内开具）信息。通过国家登记处获得截至 2021 年 12 月的主要心血管事件（MACE；死亡率、心肌梗死、中风、心力衰竭）数据。使用 Cox 比例生存分析评估预后，以任何钠-葡萄糖协同转运蛋白 2 抑制剂（SGLT2i）和胰高血糖素样肽 1 受体激动剂（GLP-1RA）作为参考的心脏保护 GLD 作为参照。
在所有患者（n=38671）中，31%为稳定型 CAD，69%发生急性心肌梗死。平均年龄为 69 岁，67%为男性，81%正在使用 GLD。近年来，心脏保护 GLD 的使用迅速增加（2016-2021 年；7-47%），并且在年轻患者（66 岁 vs. 68 岁）和男性（72.9% vs. 67.1%）中比其他 GLD 更常见。此外，与其他 GLD 相比，心脏保护 GLD 在心力衰竭（5.0% vs. 6.8%）、心肌梗死（7.7% vs. 10.5%）和慢性肾脏病（3.7% vs. 5.2%）病史较少的患者中更为常见。与心脏保护 GLD 相比，其他 GLD 患者发生 MACE 的调整后危害比（HR）（95%CI）更高（1.10；1.03-1.17，p=0.004）。2010 年至 2019 年的趋势分析显示，糖尿病合并 CAD 患者的一年 MACE 有所改善（2019 年 vs. 2010 年；0.90；0.81-1.00，p=0.045），而一年死亡率保持不变。
糖尿病合并 CAD 患者的糖尿病药物治疗模式正在迅速改变；然而，存在令人担忧的信号表明，在心血管风险较低的情况下，心脏保护 GLD 的使用效率低下，偏向于年轻和健康的个体。尽管如此，一年的发病率仍呈上升趋势。
