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心血管药物对高血糖和糖尿病的影响:“未提及”的副作用综述

The impact of cardiovascular drugs on hyperglycemia and diabetes: a review of 'unspoken' side effects.

作者信息

Widiarti Wynne, Saputra Pandit Bagus Tri, Savitri Cornelia Ghea, Putranto Johanes Nugroho Eko, Alkaff Firas Farisi

机构信息

Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.

Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia; Cardiovascular Research and Innovation Center, Universitas Airlangga, Surabaya, Indonesia.

出版信息

Hellenic J Cardiol. 2025 May-Jun;83:71-77. doi: 10.1016/j.hjc.2024.09.007. Epub 2024 Oct 9.

Abstract

AIMS

The increasing prevalence of cardiovascular diseases has led to the widespread use of cardiovascular drugs that can adversely impact glucose metabolism. This review focuses on the latest evidence on the potential of cardiovascular drugs to induce adverse glycemic effects but also the underlying mechanisms, prevention, and management strategies.

MATERIALS AND METHODS

A comprehensive literature search was conducted across scientific databases until May 25th, 2024.

RESULTS

Certain cardiovascular drugs can induce hyperglycemia through multiple mechanisms, including altered the secretion and sensitivity of insulin through direct cytotoxic effects toward pancreatic beta cells and increased glucose secretion. Notably, diuretics, beta-blockers, calcium channel blockers, and statins have been associated with significant glycemic disturbances. The risk of hyperglycemia varies based on individual factors, drug dosages, and concurrent medications. These drug-induced hyperglycemic effects may sometimes reverse upon discontinuation of related medication. Effective management should include lifestyle modifications, the use of glucose-lowering medications, and opting for lower-risk cardiovascular drugs. Monitoring for hyperglycemia involves educating affected individuals and conducting regular blood glucose tests. Identifying at-risk individuals and implementing preventive measures are crucial for improving both cardiovascular and metabolic outcomes.

CONCLUSIONS

Certain cardiovascular drugs significantly contribute to hyperglycemia and diabetes mellitus through various mechanisms. Effective management includes identifying at-risk individuals, choosing lower-risk medications, and implementing monitoring and preventive strategies. Further research is needed to fully understand these mechanisms and develop targeted interventions to prevent and manage cardiovascular drug-induced hyperglycemia, thereby improving clinical outcomes.

摘要

目的

心血管疾病患病率的不断上升导致心血管药物的广泛使用,而这些药物可能对葡萄糖代谢产生不利影响。本综述重点关注心血管药物诱导不良血糖效应的最新证据,以及潜在机制、预防和管理策略。

材料与方法

在2024年5月25日前对多个科学数据库进行了全面的文献检索。

结果

某些心血管药物可通过多种机制诱导高血糖,包括通过对胰腺β细胞的直接细胞毒性作用改变胰岛素分泌和敏感性以及增加葡萄糖分泌。值得注意的是,利尿剂、β受体阻滞剂、钙通道阻滞剂和他汀类药物与显著的血糖紊乱有关。高血糖风险因个体因素、药物剂量和同时使用的药物而异。这些药物引起的高血糖效应有时在停用相关药物后可能逆转。有效的管理应包括生活方式的改变、使用降糖药物以及选择低风险的心血管药物。对高血糖的监测包括对受影响个体进行教育并定期进行血糖检测。识别高危个体并采取预防措施对于改善心血管和代谢结局至关重要。

结论

某些心血管药物通过多种机制显著导致高血糖和糖尿病。有效的管理包括识别高危个体、选择低风险药物以及实施监测和预防策略。需要进一步研究以充分了解这些机制,并制定针对性干预措施来预防和管理心血管药物引起的高血糖,从而改善临床结局。

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