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达格列净在心力衰竭中的作用:临床试验证据概述。

Dapagliflozin's Role in Heart Failure: An Overview of Clinical Trial Evidence.

作者信息

Khan Rizwan H, Qureshi Hasham, Ahmed Zubair, Hassan Amir, Ali Syed Ahsan, Kumar Sagar, Ismail Aasia, Anthony Nouman, Shabbir Muhammad Murtaza M, Ali Umar Azam, Ullah Najeeb, Khaliq Ibrar

机构信息

Internal Medicine, Northern Ireland Medical and Dental Training Agency, Belfast, GBR.

Psychiatry, Killester Mental Health Services, Dublin, IRL.

出版信息

Cureus. 2024 Oct 2;16(10):e70727. doi: 10.7759/cureus.70727. eCollection 2024 Oct.

DOI:10.7759/cureus.70727
PMID:39493115
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11530358/
Abstract

Heart failure (HF) has become a global health threat, necessitating the development of novel treatment options to address this crisis. Sodium-glucose co-transporter-2 (SGLT2) inhibitors, such as dapagliflozin, may offer significant advantages in the treatment of HF, particularly in patients with reduced ejection fraction (HFrEF). This systematic review combines the findings from clinical studies to evaluate the safety and effectiveness of dapagliflozin in HF patients. The study results demonstrate dapagliflozin's consistent improvements in reducing adverse cardiovascular events, including cardiovascular death rates across different HF phenotypes. Mechanistically, dapagliflozin exerts diuretic and hemodynamic effects, along with its actions on myocardial metabolism, ion transporters, fibrosis, adipokines, and vascular function, which collectively contribute to its cardioprotective effects. This overview emphasizes dapagliflozin's key role in HF management, positioning it as one of the central pillars of the HF treatment regimen. Further studies are essential to fully understand dapagliflozin's long-term effectiveness, safety, and integration into routine clinical practice, ultimately improving patient outcomes in HF.

摘要

心力衰竭(HF)已成为全球健康威胁,因此需要开发新的治疗方案来应对这一危机。钠-葡萄糖协同转运蛋白2(SGLT2)抑制剂,如达格列净,在HF治疗中可能具有显著优势,尤其是在射血分数降低(HFrEF)的患者中。本系统评价综合临床研究结果,以评估达格列净在HF患者中的安全性和有效性。研究结果表明,达格列净在降低不良心血管事件方面持续改善,包括不同HF表型的心血管死亡率。从机制上讲,达格列净发挥利尿和血流动力学作用,以及对心肌代谢、离子转运体、纤维化、脂肪因子和血管功能的作用,这些共同促成了其心脏保护作用。本综述强调了达格列净在HF管理中的关键作用,将其定位为HF治疗方案的核心支柱之一。进一步的研究对于全面了解达格列净的长期有效性、安全性以及融入常规临床实践至关重要,最终改善HF患者的预后。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9ce1/11530358/9103d996237d/cureus-0016-00000070727-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9ce1/11530358/9103d996237d/cureus-0016-00000070727-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9ce1/11530358/9103d996237d/cureus-0016-00000070727-i01.jpg

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本文引用的文献

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Dapagliflozin in Patients With Heart Failure and Deterioration in Renal Function.达格列净治疗伴有肾功能恶化的心力衰竭患者。
J Am Coll Cardiol. 2023 Nov 7;82(19):1854-1863. doi: 10.1016/j.jacc.2023.08.026. Epub 2023 Aug 25.
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Dapagliflozin in heart failure with improved ejection fraction: a prespecified analysis of the DELIVER trial.达格列净治疗射血分数改善的心力衰竭:DELIVER 试验的预设分析。
Nat Med. 2022 Dec;28(12):2504-2511. doi: 10.1038/s41591-022-02102-9. Epub 2022 Dec 15.
3
Effect of Dapagliflozin on Cause-Specific Mortality in Patients With Heart Failure Across the Spectrum of Ejection Fraction: A Participant-Level Pooled Analysis of DAPA-HF and DELIVER.
达格列净对射血分数不同心衰患者的病因特异性死亡率的影响:DAPA-HF 和 DELIVER 的参与者水平汇总分析。
JAMA Cardiol. 2022 Dec 1;7(12):1227-1234. doi: 10.1001/jamacardio.2022.3736.
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The Role of Dapagliflozin in the Management of Heart Failure: An Update on the Emerging Evidence.达格列净在心力衰竭管理中的作用:新证据更新
Ther Clin Risk Manag. 2021 Aug 12;17:823-830. doi: 10.2147/TCRM.S275076. eCollection 2021.
5
Dapagliflozin in Patients with Chronic Heart Failure: A Systematic Review and Meta-Analysis.达格列净用于慢性心力衰竭患者:一项系统评价与荟萃分析
Cardiol Res Pract. 2021 Mar 30;2021:6657380. doi: 10.1155/2021/6657380. eCollection 2021.
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PRISMA 2020 statement: What's new and the importance of reporting guidelines.PRISMA 2020 声明:新内容和报告指南的重要性。
Int J Surg. 2021 Apr;88:105918. doi: 10.1016/j.ijsu.2021.105918. Epub 2021 Mar 29.
7
Patient Characteristics, Clinical Outcomes, and Effect of Dapagliflozin in Relation to Duration of Heart Failure: Is It Ever Too Late to Start a New Therapy?患者特征、临床结局以及达格列净与心力衰竭持续时间的关系:开始新的治疗是否为时过晚?
Circ Heart Fail. 2020 Dec;13(12):e007879. doi: 10.1161/CIRCHEARTFAILURE.120.007879. Epub 2020 Nov 9.
8
Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction.达格列净治疗射血分数降低的心力衰竭患者。
N Engl J Med. 2019 Nov 21;381(21):1995-2008. doi: 10.1056/NEJMoa1911303. Epub 2019 Sep 19.
9
Dapagliflozin improves left ventricular remodeling and aorta sympathetic tone in a pig model of heart failure with preserved ejection fraction.达格列净可改善射血分数保留型心力衰竭猪模型的左心室重构和主动脉交感神经张力。
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Eur J Heart Fail. 2019 Nov;21(11):1402-1411. doi: 10.1002/ejhf.1548. Epub 2019 Jul 15.