Li Shuang, Wang Longlong, Wang Peng, Xu Xiaohui, Guo Yanhua
Department of Cardiology, Qilu Hospital of Shandong University Dezhou Hospital, Dezhou, Shandong, China.
Department of Genetics and Cell Biology, School of Basic Medicine, Qingdao University, Qingdao, Shandong, China.
Front Endocrinol (Lausanne). 2025 Jun 4;16:1594861. doi: 10.3389/fendo.2025.1594861. eCollection 2025.
Myocardial infarction (MI) remains a leading cause of morbidity and mortality worldwide, frequently driven by acute coronary occlusion resulting from atherosclerosis and arrhythmias. Type 2 diabetes mellitus (T2DM) is a major risk factor for atherosclerotic progression and is associated with worsened cardiovascular outcomes in post-MI patients. Dapagliflozin, a sodium-glucose co-transporter 2 (SGLT2) inhibitor, has emerged as a novel antidiabetic agent with additional cardiovascular benefits. Increasing evidence suggests its potential utility in post-MI care, particularly in patients with coexisting T2DM.
This study aims to systematically evaluate the clinical efficacy of dapagliflozin in improving cardiac function and reducing adverse cardiovascular events in post- MI patients with and without diabetes.
A systematic search of PubMed, Embase, Web of Science, Cochrane Library, CNKI, and WanFang databases identified relevant clinical studies up to May 22, 2024. Eligible randomized controlled trials (RCTs) and retrospective cohort studies were analyzed using Review Manager 5.3.
19 studies (12 RCTs and 7 cohort studies) with 7,128 patients were included. Meta-analysis showed dapagliflozin significantly reduced key cardiac biomarkers and structural parameters, including NT-proBNP (MD = -62.06, 95% CI [-94.59, -29.53], P = 0.0002), LVEDD (MD = -2.58, 95% CI [-3.64, -1.52], P < 0.00001), and LVESD (MD = -2.32, 95% CI [-2.99, -1.66], P < 0.00001), while enhancing LVEF (MD = 3.88, 95% CI [2.24, 5.52], P < 0.00001). It also reduced major adverse cardiovascular events (RR = 0.33, 95% CI [0.18, 0.60], P < 0.05), and heart failure-related rehospitalization (RR = 0.53, 95% CI [0.30, 0.91], P < 0.05). Subgroup analysis revealed consistent cardioprotective benefits in both diabetic and non-diabetic populations.
Dapagliflozin significantly enhances cardiac function and reduces adverse cardiovascular events in post-MI patients, independent of diabetes status. These findings support the integration of dapagliflozin into post-MI management strategies. Further large-scale, long-term clinical trials are needed to assess its impact on recurrent MI and long-term survival outcomes.
心肌梗死（MI）仍是全球发病和死亡的主要原因，通常由动脉粥样硬化和心律失常导致的急性冠状动脉闭塞引起。2型糖尿病（T2DM）是动脉粥样硬化进展的主要危险因素，与心肌梗死后患者心血管结局恶化相关。达格列净，一种钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂，已成为一种具有额外心血管益处的新型抗糖尿病药物。越来越多的证据表明其在心肌梗死后护理中的潜在效用，特别是在合并T2DM的患者中。
本研究旨在系统评价达格列净在改善有或无糖尿病的心肌梗死后患者心脏功能和减少不良心血管事件方面的临床疗效。
对PubMed、Embase、Web of Science、Cochrane图书馆、中国知网和万方数据库进行系统检索，以确定截至2024年5月22日的相关临床研究。使用Review Manager 5.3对符合条件的随机对照试验（RCT）和回顾性队列研究进行分析。
纳入19项研究（12项RCT和7项队列研究），共7128例患者。荟萃分析显示，达格列净显著降低关键心脏生物标志物和结构参数，包括N末端脑钠肽前体（NT-proBNP）（MD = -62.06，95%CI[-94.59，-29.53]，P = 0.0002）、左心室舒张末期内径（LVEDD）（MD = -2.58，95%CI[-3.64，-1.52]，P < 0.00001）和左心室收缩末期内径（LVESD）（MD = -2.32，95%CI[-2.99，-1.66]，P < 0.00001），同时提高左心室射血分数（LVEF）（MD = 3.88，95%CI[2.24，5.52]，P < 0.00001）。它还降低了主要不良心血管事件（RR = 0.33，95%CI[0.18，0.60]，P < 0.05）和心力衰竭相关再住院率（RR = 0.53，95%CI[0.30，0.91]，P < 0.05）。亚组分析显示，在糖尿病和非糖尿病人群中均有一致的心脏保护益处。
达格列净显著改善心肌梗死后患者的心脏功能并减少不良心血管事件，与糖尿病状态无关。这些发现支持将达格列净纳入心肌梗死后管理策略。需要进一步的大规模、长期临床试验来评估其对复发性心肌梗死和长期生存结局的影响。
