Maik Mohammad H B A, Ibtisam Muhammad, Sheikh Sarah, Malik Muhammad A B A, Ihsan Ayesha, Arham Muhammad, Haq Usman, Parveen Abida
Department of Medicine, Ibn e Seena Hospital, Kabul, Afghanistan.
J Community Hosp Intern Med Perspect. 2025 Jul 3;15(4):29-33. doi: 10.55729/2000-9666.1505. eCollection 2025.
Atherosclerosis, a major cause of cardiovascular morbidity and mortality, involves lipid accumulation, endothelial dysfunction, inflammation, and oxidative stress. Sodium-glucose cotransporter-2 (SGLT2) inhibitors, initially developed for type 2 diabetes mellitus (T2DM), have demonstrated cardiovascular benefits beyond glycemic control. Emerging evidence suggests their potential role in slowing atherosclerosis progression and enhancing plaque stability.
A systematic review of PubMed, Scopus, Embase, and Cochrane Library databases was conducted to identify preclinical and clinical studies on SGLT2 inhibitors and atherosclerosis. Studies published in English up to December 2024 were screened using predefined criteria. Data on mechanisms, lipid metabolism, endothelial function, vascular inflammation, and plaque stability were extracted, and study quality was assessed.
A total of 16 animal and 4 human studies were included. SGLT2 inhibitors (empagliflozin, dapagliflozin, and canagliflozin) improved glycemic control, lipid metabolism, and atheroma reduction while enhancing plaque stability. They modestly reduced triglycerides and LDL-C while increasing HDL-C. SGLT2 inhibitors also decreased vascular inflammation and enhanced plaque stability by increasing fibrous cap thickness. Cardiovascular outcome trials demonstrated reductions in major adverse cardiovascular events (MACE) and heart failure hospitalizations, indirectly supporting their atheroprotective role.
SGLT2 inhibitors offer a multifaceted approach to atherosclerosis management by improving lipid metabolism, endothelial function, vascular inflammation, and plaque stability. While evidence is promising, further research is needed to confirm direct anti-atherosclerotic effects, optimize their role in cardiovascular care.
动脉粥样硬化是心血管疾病发病和死亡的主要原因，涉及脂质蓄积、内皮功能障碍、炎症和氧化应激。最初用于治疗2型糖尿病（T2DM）的钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂已显示出超出血糖控制的心血管益处。新出现的证据表明它们在减缓动脉粥样硬化进展和增强斑块稳定性方面具有潜在作用。
对PubMed、Scopus、Embase和Cochrane图书馆数据库进行系统综述，以确定关于SGLT2抑制剂与动脉粥样硬化的临床前和临床研究。使用预定义标准筛选截至2024年12月以英文发表的研究。提取有关机制、脂质代谢、内皮功能、血管炎症和斑块稳定性的数据，并评估研究质量。
共纳入16项动物研究和4项人体研究。SGLT2抑制剂（恩格列净、达格列净和卡格列净）改善了血糖控制、脂质代谢并减少了动脉粥样硬化，同时增强了斑块稳定性。它们适度降低了甘油三酯和低密度脂蛋白胆固醇（LDL-C），同时提高了高密度脂蛋白胆固醇（HDL-C）。SGLT2抑制剂还通过增加纤维帽厚度降低了血管炎症并增强了斑块稳定性。心血管结局试验表明主要不良心血管事件（MACE）和心力衰竭住院率降低，间接支持了它们的动脉粥样硬化保护作用。
SGLT2抑制剂通过改善脂质代谢、内皮功能、血管炎症和斑块稳定性，为动脉粥样硬化管理提供了多方面的方法。虽然证据很有前景，但仍需要进一步研究来证实其直接抗动脉粥样硬化作用，优化它们在心血管护理中的作用。
