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探索胰高血糖素样肽-1受体激动剂在管理心血管并发症方面的临床疗效:最新综合综述及未来指导意见。

Exploring the clinical effectiveness of glucagon-like peptide-1 receptor agonists in managing cardiovascular complications: an updated comprehensive review and future directives.

作者信息

Joshi Nandan, Qasim Muhammad Zohaib, Kanumilli Srilakshmidevi, Shaukat Faiza, Kumar Ateesh, Mahek Fnu, Khalid Saif, Zeeshan Mohd, Shaik Mahboob Younus, Nishat Syeed Mahmud, Gandhi Fenil, Belletieri Christopher

机构信息

Department of Internal Medicine, Surat Municipal Institute of Medical Education and Research, Surat.

Department of Internal Medicine, Quaid-e-Azam Medical College, Bahawalpur.

出版信息

Ann Med Surg (Lond). 2024 Aug 22;86(10):5947-5956. doi: 10.1097/MS9.0000000000002494. eCollection 2024 Oct.

Abstract

The possible cardiovascular advantages of glucagon-like peptide-1 receptor agonists (GLP-1RAs), a class of drugs predominantly used to treat type 2 diabetes (T2D), have garnered increasing attention in recent years. Clinical trials have looked into the possibility that GLP-1RAs have extra cardioprotective benefits in addition to their ability to manage T2D, demonstrating significant major adverse cardiovascular events (MACE) reduction and a favorable safety profile. GLP-1 RAs improve cardiovascular outcomes, especially in those with existing cardiovascular disease. MACE has been steadily declining with this class of drugs, which results in a noticeable rise in cardiovascular outcome trials (CVOTs). GLP-1 RAs have a variety of impacts on the cardiovascular system beyond their function in glycemic control. They offer direct cardioprotection, vasodilation, promotion of salt excretion, reduction of weight, improved lipid profile, and anti-inflammatory qualities through a variety of mechanisms. Thus, this review focuses on GLP-1RAs, its mechanism of action, its clinical effectiveness in CVOTs, the mechanism behind its cardiovascular benefits, its potential role in heart failure, cardiovascular outcomes, its underutilization, and future directives. In conclusion, GLP-1 RAs shows potential in controlling T2D while also lowering cardiovascular risk, but warrants further study into long-term results and real-world data to optimize treatment regimens, ultimately increasing patient outcomes and lowering the burden of cardiovascular disease in T2D populations.

摘要

胰高血糖素样肽-1受体激动剂(GLP-1RAs)是一类主要用于治疗2型糖尿病(T2D)的药物,其潜在的心血管益处近年来受到越来越多的关注。临床试验探讨了GLP-1RAs除了具有控制T2D的能力外,是否还具有额外的心脏保护作用,结果显示其能显著降低主要不良心血管事件(MACE),且安全性良好。GLP-1RAs可改善心血管结局,尤其是在已有心血管疾病的患者中。使用这类药物后MACE持续下降,这导致心血管结局试验(CVOTs)显著增加。GLP-1RAs对心血管系统有多种影响,超出了其在血糖控制方面的作用。它们通过多种机制提供直接的心脏保护、血管舒张、促进排盐、减轻体重、改善血脂谱以及抗炎特性。因此,本综述聚焦于GLP-1RAs、其作用机制、在CVOTs中的临床疗效、心血管益处背后的机制、其在心力衰竭中的潜在作用、心血管结局、其未充分利用情况以及未来的指导方向。总之,GLP-1RAs在控制T2D的同时降低心血管风险方面显示出潜力,但仍需进一步研究长期结果和真实世界数据,以优化治疗方案,最终改善患者结局并减轻T2D人群的心血管疾病负担。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f8fc/11444620/57299b9309a0/ms9-86-5947-g001.jpg

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