Diabetes Care:利拉鲁肽降低心血管风险的介导因素

2020-05-05 MedSci原创 MedSci原创

这些分析明确了HbA1c和UACR是利拉鲁肽发挥CV效应的潜在介导因素。这两个因素究竟是未评估因素的标志还是真正的介导因素,仍然是需要进一步研究的关键问题。

LEADER试验(ClinicalTrials.gov登记号为NCT01179048)结果证实了相比于安慰剂,2型糖尿病患者接受胰高血糖素样肽1受体激动剂利拉鲁肽治疗后发生心血管(CV)事件的风险降低,但CV收益潜在的介导机制仍不清楚。近日,糖尿病领域权威杂志Diabetes Care上发表了一篇研究文章,研究人员旨在明确LEADER试验中观察到的利拉鲁肽CV获益的潜在介导机制。

研究人员进行了探索性分析,以确定利拉鲁肽对下列影响主要不良CV事件(MACE; CV死亡、非致命性心肌梗塞或非致命性卒中的复合事件)的潜在介导机制:糖化血红蛋白(HbA1c)、身体体重、尿白蛋白/肌酐比率(UACR)、确诊的低血糖症、使用磺酰脲、使用胰岛素、收缩压和LDL胆固醇。研究人员选择这些候选机制作为利拉鲁肽在LEADER试验中有益的CV危险因素,从而可以降低CV风险。研究人员使用了两种基于Cox比例风险模型的方法和新的Vansteelandt方法,以控制混杂因素。

研究人员使用Cox方法和Vansteelandt方法进行的分析表明,利拉鲁肽对MACE的效应可能由HbA1c(分别高达41%和83%)和UACR(分别高达29%和33%)所介导。而其他候选机制的介导效应很小。

由此可见,这些分析明确了HbA1c和UACR是利拉鲁肽发挥CV效应的潜在介导因素。这两个因素究竟是未评估因素的标志还是真正的介导因素,仍然是需要进一步研究的关键问题。

原始出处:

John B. Buse,et al.Cardiovascular Risk Reduction With Liraglutide: An Exploratory Mediation Analysis of the LEADER Trial.Diabetes Care.2020.https://doi.org/10.2337/dc19-2251

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    2020-05-05 天地飞扬

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既往临床试验表明,对于已有心血管疾病或者有高危风险的2型糖尿病患者,GLP-1受体激动剂利拉鲁肽可以显着降低主要心血管事件的发生。那么,在真实世界临床诊疗中,利拉鲁肽的实际疗效如何呢?2019年2月份发表在《Lancet Diabetes & Endocrinology》上的一项最新研究,使用了丹麦和瑞典的全国注册登记数据(时间范围从2010年1月1日到2016年的12月31日),探讨2型

文献速递:胰岛素与利拉鲁肽联用疗效及安全性究竟如何?

GLP-1受体激动剂联合胰岛素可以有效治疗2型糖尿病,但是缺乏长期随访数据。近期,一项研究通过分析 LEADER 研究的亚组人群数据,评估了利拉鲁肽联合胰岛素治疗36个月时的疗效和安全性。注:LEADER研究是一项针对有心血管疾病高风险的2型糖尿病患者的随机双盲安慰剂对照试验,结果显示,利拉鲁肽可以显着降低2型糖尿病患者主要复合终点事件(心血管死亡、非致死性心肌梗死、非致死性卒中)的发生。主要研究