Li Fei, Baheti Rewaan, Jin Mengying, Xiong Wei, Duan Jiawei, Fang Peng, Wan Jing
Department of Cardiovascular Medicine, Zhongnan Hospital of Wuhan University, No 169 Donghu Road, Wuchang District, Wuhan, 430071, Hubei Province, China.
Department of Cardiology and Thirsty Diseases, Jiangxia District Traditional Chinese Medicine Hospital, Wuhan, 430200, China.
Diabetol Metab Syndr. 2024 Dec 18;16(1):299. doi: 10.1186/s13098-024-01553-z.
This study aimed to evaluate the real-world impact of sodium-glucose cotransporter 2 inhibitors (SGLT2i) on the efficacy, safety, and metabolic profiles of patients with chronic heart failure (CHF), both with and without type 2 diabetes mellitus (T2DM).
A cohort of 1,130 patients with reduced ejection fraction chronic heart failure (HFrEF) was recruited from Zhongnan Hospital of Wuhan University, spanning January 2021 to August 2023. Among these, 154 patients received SGLT2i therapy, while 131 patients were assigned to a non-SGLT2i group, following specified inclusion and exclusion criteria. The association between SGLT2i therapy and the risk of primary and secondary endpoints was analyzed, alongside the effect of guideline-recommended heart failure medications at varying dosages on Major Adverse Cardiovascular Events (MACE).
SGLT2i treatment led to reductions in blood pressure, uric acid, NT-proBNP, and pulmonary artery pressure, while increasing body mass index (BMI) and left ventricular ejection fraction (LVEF) in CHF patients. Multivariate Cox regression analysis revealed that SGLT2i therapy reduced the primary endpoint risk by 40.3% (HR 0.597, 95% CI 0.356-0.973, p = 0.047). Univariate Cox regression indicated that SGLT2i might also reduce the incidence of new diagnoses of atrial fibrillation, non-fatal acute myocardial infarction, and MACE in CHF patients. Moreover, the use of a four-drug combination for heart failure management was associated with a lower risk of MACE compared to monotherapy.
SGLT2i therapy not only enhances LVEF but also significantly reduces ambulatory blood pressure, uric acid, fasting blood glucose, pulmonary artery pressure, and NT-proBNP levels in CHF patients. Additionally, SGLT2i improves prognosis by lowering the risk of both primary and secondary endpoints. Compared to monotherapy, a four-drug regimen for CHF substantially reduces the risk of MACE, supporting the effectiveness of comprehensive treatment strategies.
本研究旨在评估钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）对慢性心力衰竭（CHF）患者（无论有无2型糖尿病（T2DM））的疗效、安全性和代谢谱的实际影响。
从武汉大学中南医院招募了1130例射血分数降低的慢性心力衰竭（HFrEF）患者，时间跨度为2021年1月至2023年8月。其中，154例患者接受SGLT2i治疗，131例患者根据特定的纳入和排除标准被分配到非SGLT2i组。分析SGLT2i治疗与主要和次要终点风险之间的关联，并分析不同剂量的指南推荐的心力衰竭药物对主要不良心血管事件（MACE）的影响。
SGLT2i治疗导致CHF患者血压、尿酸、NT-proBNP和肺动脉压降低，同时体重指数（BMI）和左心室射血分数（LVEF）增加。多变量Cox回归分析显示，SGLT2i治疗使主要终点风险降低了40.3%（HR 0.597，95%CI 0.356-0.973，p = 0.047）。单变量Cox回归表明，SGLT2i还可能降低CHF患者新发房颤、非致命性急性心肌梗死和MACE的发生率。此外，与单药治疗相比，使用四种药物联合治疗心力衰竭与较低的MACE风险相关。
SGLT2i治疗不仅可提高LVEF，还能显著降低CHF患者的动态血压、尿酸、空腹血糖、肺动脉压和NT-proBNP水平。此外，SGLT2i通过降低主要和次要终点风险来改善预后。与单药治疗相比，CHF的四联药物方案可大幅降低MACE风险，支持综合治疗策略的有效性。
