2型糖尿病和动脉粥样硬化性心血管疾病患者不良事件报告所捕获的心力衰竭结局:VERTIS CV试验的观察结果
Heart failure outcomes captured by adverse event reporting in participants with type 2 diabetes and atherosclerotic cardiovascular disease: Observations from the VERTIS CV trial.
作者信息
Pandey Ambarish, Kolkailah Ahmed A, McGuire Darren K, Frederich Robert C, Cater Nilo B, Cosentino Francesco, Pratley Richard E, Dagogo-Jack Samuel, Cherney David Z I, Wynant Willy, Gantz Ira, Mancuso James P, Masiukiewicz Urszula, Cannon Christopher P
机构信息
Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA.
Parkland Health System, Dallas, TX, USA.
出版信息
Eur J Heart Fail. 2025 Mar;27(3):521-526. doi: 10.1002/ejhf.3511. Epub 2025 Jan 10.
AIMS
In VERTIS CV, ertugliflozin was associated with a 30% risk reduction for adjudication-confirmed, first and total hospitalizations for heart failure (HHF) in participants with type 2 diabetes and atherosclerotic cardiovascular disease. We evaluated the impact of ertugliflozin on the broader spectrum of all reported heart failure (HF) events independent of adjudication confirmation.
METHODS AND RESULTS
Data from participants who received ertugliflozin (5 or 15 mg) were pooled and compared versus placebo. HF events included all investigator-reported HF adverse events (AEs) and serious AEs (SAEs) based on the narrow standardized Medical Dictionary for Regulatory Activities (MedDRA) query 'cardiac failure'. Terms for orthopnoea, dyspnoea, and peripheral oedema were evaluated separately. The effect of ertugliflozin on the first HF event was assessed by Cox proportional hazard models. Total HF events were assessed by Andersen-Gill models to account for first and recurrent events. A total of 8238 participants received ≥1 dose of ertugliflozin or placebo (mean follow-up 3.5 years). Investigator-reported HF events and AE capture yielded 420 first and 627 total HF events (vs. 238 and 345 adjudication-confirmed HHF events, respectively, in the primary analyses). Ertugliflozin reduced the risk for first (hazard ratio [HR] 0.69; 95% confidence interval [CI] 0.57-0.84; p < 0.001) and total HF AEs (HR 0.66; 95% CI 0.57-0.78; p < 0.001), with similar results for first and total HF SAEs. Additionally, ertugliflozin reduced oedema risk, but not orthopnoea/dyspnoea.
CONCLUSION
The effect of ertugliflozin was consistent across the spectrum of total investigator-reported HF AEs and was similar in magnitude to adjudicated HHF events.
目的
在VERTIS CV研究中,对于2型糖尿病和动脉粥样硬化性心血管疾病患者,恩格列净与经判定确认的首次及因心力衰竭(HHF)导致的总住院风险降低30%相关。我们评估了恩格列净对所有报告的心力衰竭(HF)事件(不考虑判定确认)更广泛范围的影响。
方法与结果
汇总接受恩格列净(5或15毫克)治疗的参与者的数据,并与安慰剂进行比较。HF事件包括所有研究者报告的基于狭窄标准化监管活动医学词典(MedDRA)查询“心力衰竭”的HF不良事件(AE)和严重不良事件(SAE)。分别评估端坐呼吸、呼吸困难和外周水肿的术语。通过Cox比例风险模型评估恩格列净对首次HF事件的影响。通过Andersen-Gill模型评估总HF事件,以考虑首次和复发事件。共有8238名参与者接受了≥1剂恩格列净或安慰剂(平均随访3.5年)。研究者报告的HF事件和AE捕获产生了420例首次HF事件和627例总HF事件(在主要分析中,判定确认的HHF事件分别为238例和345例)。恩格列净降低了首次(风险比[HR]0.69;95%置信区间[CI]0.57 - 0.84;p < 0.001)和总HF AE的风险(HR 0.66;95% CI 0.57 - 0.78;p < 0.001),首次和总HF SAE的结果相似。此外,恩格列净降低了水肿风险,但未降低端坐呼吸/呼吸困难风险。
结论
恩格列净在研究者报告的总HF AE范围内的作用是一致的,其幅度与判定的HHF事件相似。