Zhang Alian, Yu Jianying, Ke Jiahan, Yin Ping, Zhang Junfeng, Wang Changqian, Tang Zhengde, Gu Jun
Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.
Shanghai Putuo Mental Health Center, Shanghai, China.
Kardiol Pol. 2025;83(7-8):814-822. doi: 10.33963/v.phj.106152. Epub 2025 May 14.
The prevalence of diabetic cardiomyopathy (DiabCM) is increasing in parallel with diabetes mellitus, with no consensus on targeted treatment.
This study aims to investigate the cardiovascular benefits of sodium-glucose cotransporter-2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) alone and combination on symptomatic DiabCM participants.
This was a single-center prospective cohort study focusing on patients with symptomatic DiabCM. The study comprised 587 participants: 154 in the SGLT2is group, 105 in the GLP-1RAs group, 93 in the SGLT2is combined with GLP-1RAs group (SGLT2is + GLP-1RAs), and 235 in the control group (without SGLT2is or GLP-1RAs). All participants were followed for 36 months. The primary outcome was a composite of all-cause death and hospitalization for heart failure.
The incidence of endpoint event was lowest in the SGLT2is + GLP-1RAs group (23.7%), followed by the SGLT2is group (32.5%), GLP-1RAs group (39.0%), and control group (53.6%). Multivariable Cox regression analysis showed that SGLT2is (P <0.001), GLP-1RAs (P = 0.02) or SGLT2is + GLP-1RAs prescription (P <0.001) were independent protective factors for the occurrence of primary outcome. In subgroup analysis, SGLT2is or SGLT2is + GLP-1RAs treatment remained the independent factors for freedom from primary outcome in both heart failure with reduced ejection fraction + heart failure with mildly reduced ejection fraction and heart failure with preserved ejection fraction patients. However, GLP-1RAs alone did not exert clinical benefits in subgroup analysis.
SGLT2is and GLP-1RAs might reduce the incidence of all-cause mortality and heart failure hospitalization in patients with symptomatic DiabCM, and the combination of these two agents may further improve clinical outcomes.
糖尿病性心肌病（DiabCM）的患病率与糖尿病同步上升，针对其治疗尚无共识。
本研究旨在调查钠-葡萄糖协同转运蛋白2抑制剂（SGLT2is）和胰高血糖素样肽1受体激动剂（GLP-1RAs）单独及联合使用对有症状的DiabCM参与者的心血管益处。
这是一项针对有症状的DiabCM患者的单中心前瞻性队列研究。该研究包括587名参与者：SGLT2is组154人，GLP-1RAs组105人，SGLT2is联合GLP-1RAs组（SGLT2is + GLP-1RAs）93人，对照组（未使用SGLT2is或GLP-1RAs）235人。所有参与者均随访36个月。主要结局是全因死亡和心力衰竭住院的复合结局。
SGLT2is + GLP-1RAs组的终点事件发生率最低（23.7%），其次是SGLT2is组（32.5%）、GLP-1RAs组（39.0%）和对照组（53.6%）。多变量Cox回归分析显示，SGLT2is（P <0.001）、GLP-1RAs（P = 0.02）或SGLT2is + GLP-1RAs处方（P <0.001）是主要结局发生的独立保护因素。在亚组分析中，SGLT2is或SGLT2is + GLP-1RAs治疗在射血分数降低的心力衰竭+射血分数轻度降低的心力衰竭以及射血分数保留的心力衰竭患者中仍是免于主要结局的独立因素。然而，单独使用GLP-1RAs在亚组分析中未显示出临床益处。
SGLT2is和GLP-1RAs可能降低有症状的DiabCM患者的全因死亡率和心力衰竭住院率，这两种药物联合使用可能进一步改善临床结局。
