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钠-葡萄糖协同转运蛋白2抑制剂对2型糖尿病患者脂蛋白的影响

Impact of SGLT2 Inhibitors on Lipoproteins in Type 2 Diabetes.

作者信息

Corral Pablo, Nardelli Natalia, Elbert Alicia, Aranguren Florencia, Schreier Laura

机构信息

Facultad de Medicina, Departamento de Farmacología e Investigación, Universidad FASTA, Instituto de Investigaciones Clínicas (IIC), Mar del Plata, Argentina.

Centro de Nutrición y Diabetes (CENUDIAB), Ciudad Autónoma de Buenos Aires, Argentina.

出版信息

Curr Diab Rep. 2025 Jan 7;25(1):16. doi: 10.1007/s11892-024-01572-0.

Abstract

PURPOSE OF REVIEW

This article explores the cardiovascular effects of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in patients with type 2 diabetes mellitus (T2DM), with a particular focus on their impact on lipid profiles. As evidence grows of the cardiovascular benefits of SGLT2i beyond glucose control, it is essential to better understand their effects on lipoproteins and their impact on cardiovascular disease.

RECENT FINDINGS

SGLT2i have shown significant cardiovascular benefits in patients with type 2 diabetes mellitus, beyond their role in lowering blood glucose. Studies indicate that SGLT2i reduce major adverse cardiovascular events by impacting factors such as blood pressure, body weight, and arterial stiffness. However, their effects on lipid profile remain complex and somewhat inconsistent. Some research points to modest increases in LDL cholesterol, while others report shifts toward less atherogenic lipid profile, including reductions in triglycerides and small, dense LDL particles, and increases in HDL-C. SGLT2i represent a significant advancement in managing diabetes and associated cardiovascular risks, with benefits such as triglyceride reduction and HDL-C increase. While their impact on LDL-C remains controversial and varies across studies, the reduction of small, dense LDL particles may mitigate negative effects. This article highlights the need for future research to better understand the specific mechanisms behind lipid modulation.

摘要

综述目的

本文探讨了钠-葡萄糖协同转运蛋白2抑制剂(SGLT2i)对2型糖尿病(T2DM)患者心血管系统的影响,尤其关注其对血脂谱的作用。随着越来越多的证据表明SGLT2i除了控制血糖外还具有心血管益处,更深入了解其对脂蛋白的影响及其对心血管疾病的作用至关重要。

最新发现

SGLT2i在2型糖尿病患者中已显示出显著的心血管益处,超出了其降低血糖的作用。研究表明,SGLT2i通过影响血压、体重和动脉僵硬度等因素来减少主要不良心血管事件。然而,它们对血脂谱的影响仍然复杂且有些不一致。一些研究指出低密度脂蛋白胆固醇(LDL-C)略有升高,而另一些研究则报告血脂谱向致动脉粥样硬化性降低转变,包括甘油三酯和小而密的LDL颗粒减少,以及高密度脂蛋白胆固醇(HDL-C)升高。SGLT2i在管理糖尿病及相关心血管风险方面代表了一项重大进展,具有降低甘油三酯和升高HDL-C等益处。虽然它们对LDL-C的影响仍存在争议且因研究而异,但小而密LDL颗粒的减少可能减轻负面影响。本文强调了未来研究需要更好地理解脂质调节背后的具体机制。

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