JAMA Cardiol:达格列净对2型糖尿病心肾结局的保护作用不受心血管药物的影响

2022-08-05 MedSci原创 MedSci原创

达格列净始终如一地降低了2型糖尿病患者的心血管和肾脏结局的风险

达格列净已被证明可以改善2型糖尿病患者的心血管 (CV) 和肾脏预后。但是,目前关于2型糖尿病患者同时使用心血管药物与达格列净的疗效和安全性的关系的相关数据有限。

该研究旨在评估在有和无使用心血管药物的背景下,达格列净对2型糖尿病患者的心肾疗效和安全性是否一致。

这是对DECLARE-TIMI 58试验进行的预定的二次分析,在该试验中,17160位2型糖尿病患者随机接受达格列净或安慰剂治疗,受试患者合并动脉粥样硬化疾病或存在多种心血管疾病的风险因素。根据患者基线有无使用心血管药物进行分层:ACEI/ARB、β受体阻滞剂、利尿剂和盐皮质激素受体阻断剂(MRA)。主要终点是心血管死亡或心衰住院(HHF)的复合结局、单HHF和肾脏特异性的复合结局(eGFR持续降低≥40%、终末期肾病或肾性死亡)。


达格列净对各项终点事件风险的影响

在17160位患者中,基线时有13950位(81%)在使用ACEI/ARB,9030位(53%)在使用β受体阻滞剂,6205位(36%)在使用利尿剂,762位(4%)在使用MRA。48个月时,与安慰剂相比,达格列净在血压和eGFR方面的改变无明显差异,无论同时在接受什么药物治疗(安慰剂校正的改变:-1.6mmHg~-2.6mmHg,p>0.05)。无论背景治疗药物如何,达格列净都可一致地降低心血管死亡/HHF、单HHF和肾脏特异性复合结局的风险(HR:0.50~0.82,p>0.05)。

在接受ACEI/ARB+β受体阻滞剂+利尿剂治疗的患者(n=4243)中,达格列净治疗使其心血管死亡/HHF和肾脏特异性复合结局的风险分别降低了24%和38%。在容量减少、急性肾损伤或高钾血症等不良事件中,达格列净与同步使用的心血管药物没有显著的治疗相互作用。

综上,达格列净始终如一地降低了2型糖尿病患者的心血管和肾脏结局的风险,且不受各种心血管药物的影响。该研究证明,达格列净在广泛的2型糖尿病患者中的具有很好临床效益和安全性。

原始出处:

Oyama K, Raz I, Cahn A, et al. Efficacy and Safety of Dapagliflozin According to Background Use of Cardiovascular Medications in Patients With Type 2 Diabetes: A Prespecified Secondary Analysis of a Randomized Clinical Trial. JAMA Cardiol. Published online July 20, 2022. doi:10.1001/jamacardio.2022.2006

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    2022-08-05 肿瘤克星

    JAMA上文章都是顶级的,谢谢梅斯及时上新

    0

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世界范围内对T2DM患病率预测显示,发展中国家患病率增加70%,发达国家增加20%。尽管糖尿病单一降糖方案有效,但大约50%的患者在3年后需要额外的药物治疗才能达到目标糖化血红蛋白(A1C) < 7%