Cardiovasc Diabetol:不同SGLT2抑制剂对糖尿病患者心血管不良结局风险的影响

2022-05-20 MedSci原创 MedSci原创

不同SGLT2抑制剂对糖尿病患者后续发生心力衰竭、心肌梗死、心绞痛、卒中和房颤的风险的影响不相上下。

钠-葡萄糖协同转运蛋白 2 (SGLT2) 抑制剂是一种临床常用的口服抗糖尿病药物,通过抑制肾近端小管对葡萄糖的再吸收来促进葡萄糖的尿排泄,从而降低血糖水平。既往随机临床试验证明,SGLT2 抑制剂可改善糖尿病患者的心血管结局。

但目前很少有对比个别SGLT2抑制剂对糖尿病患者心血管结局的影响的数据。该研究旨在比较单个SGLT2抑制剂对糖尿病患者心血管疾病风险的影响。

研究人员分析了25315位刚开始服用SGLT2抑制剂的糖尿病患者(恩格列净:5302位;达格列净:4681位;卡格列净:4411位;其他SGLT2抑制剂:10921位)。研究人员对比了不同SGLT2抑制剂服用者之间发生心力衰竭(HF)、心肌梗死(MI)、心绞痛(AP)、卒中和房颤(AF)的风险。


受试患者的基线特征

受试患者的中位年龄是52岁,82.5%的男性。中位空腹血糖是149 mg/dL,中位HbA1c水平是7.5%。平均随访了814±591天,共记录了855例心衰、143例心肌梗死、815例心绞痛、340例卒中和139例房颤事件。


不同SGLT2抑制剂对各种心血管不良结局风险的影响

与恩格列净相比,服用达格列净、卡格列净和其他SGLT2抑制剂的患者发生心衰、心肌梗死、心绞痛、卒中和房颤的风险无明显差异。对于发生心衰,与恩格列净相比,服用达格列净、卡格列净和其他SGLT2抑制剂的患者发生心衰的风险比分别是1.02、1.08和0.88。

Wald测试表明,服用不同SGLT2抑制剂的患者发生心衰、心肌梗死、心绞痛、卒中和房颤的风险均没有显著差异。研究人员进通过大量的敏感性分析证实了上述结果的稳健性。

综上所述,不同SGLT2抑制剂对糖尿病患者后续发生心力衰竭、心肌梗死、心绞痛、卒中和房颤的风险的影响不相上下。该研究是首个使用大规模真实世界数据比较不同SGLT2抑制剂对糖尿病患者的广泛心血管结局的影响的研究。

 

原始出处:

Suzuki, Y., Kaneko, H., Okada, A. et al. Comparison of cardiovascular outcomes between SGLT2 inhibitors in diabetes mellitus. Cardiovasc Diabetol 21, 67 (2022). https://doi.org/10.1186/s12933-022-01508-6.

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    2022-09-20 quxin068
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    2023-01-24 jklm09
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    2022-06-18 docwu2019
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    2022-08-22 tulenzi
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