Circulation:卡格列净降低HFpEF和HFrEF的心衰事件风险

2019-07-01 国际循环编辑部 国际循环

近期,一项基于卡格列净CANVAS研究进行的亚组分析结果于Circulation杂志发表。该分析对卡格列净对射血分数保留心衰(HFpEF)及射血分数降低心衰(HFrEF)的心衰事件风险的影响进行了报道。对糖尿病合并心衰的治疗策略来说,此结果无疑提供了更多有力证据。

近期,一项基于卡格列净CANVAS研究进行的亚组分析结果于Circulation杂志发表。该分析对卡格列净对射血分数保留心衰(HFpEF)及射血分数降低心衰(HFrEF)的心衰事件风险的影响进行了报道。对糖尿病合并心衰的治疗策略来说,此结果无疑提供了更多有力证据。

2型糖尿病已成为全球健康与经济杀手,是目前慢病管理的焦点,而它与心衰的交集之路也由来已久。SGLT2抑制剂卡格列净为一种新型降糖药,其大型心血管结局临床研究CANVAS研究结果显示,在2型糖尿病合并心血管高危风险或确诊心血管疾病的患者中,卡格列净可显著降低因心衰入院风险。然而,在HFpEF及HFrEF患者中,卡格列净能否降低心衰风险呢?

CANVAS研究

CANVAS研究为一项覆盖30个国家或地区667个中心,纳入10 142例心血管一级预防(35%)与二级预防(65%)2型糖尿病患者的大型RCT临床研究。结果证实,平均随访188.2周之后,卡格列净治疗可显著降低3点MACE(心血管死亡、非致死性卒中、非致死性心肌梗死)风险达14%,同时显著降低研究总体人群心血管死亡或心衰住院风险达22%。

为了解卡格列净对HFpEF及HFrEF的心衰事件风险的影响,由CANVAS研究原评审委员会成员对研究记录中EF保留或降低的医疗数据进行回顾性二次审查。在心衰住院期间,患者EF通过超声心动图或左室造影检查获取,并被记录在案。根据定义,EF≥50%的心衰事件定义为HFpEF,而HFrEF定义为EF<50%的心衰事件或之前有一份关于EF降低的报告但没有记录恢复的证据。所有其他心衰事件均定义为HFuEF(EF未知的心衰)。

在CANVAS研究纳入的患者中,1461例(14.4%)患者基线时有心衰病史。随访期间,276例患者经历一次致死性或需住院治疗的心衰,61例患者经历>1次心衰事件。其中,101例患者是HFpEF,122例患者经历HFrEF,另有61例患者为HFuEF,以上心衰事件数>276例是因为有8例患者经历了>1种心衰事件(如第1年为HFuEF,而第2年为HFrEF)。

之前已有研究报道,相较于安慰剂组,卡格列净治疗可降低致死性或需住院的心衰事件风险30%(HR=0.70;95%CI:0.55~0.89)。从此次分析可以看到(图1),卡格列净在各个亚组均可降低致死性或需住院的心衰事件风险,在HFrEF或HFuEF组中降低风险29%(HR=0.71;0.52~0.97),在HFpEF或HFuEF组降低风险36%(HR=0.64;0.48~0.86)。



图1. 卡格列净对HFrEF、HFpEF和HFuEF所有致死性或需住院的心衰以及心衰的影响

总体而言,卡格列净可降低心血管高危的2型糖尿病患者心衰事件风险,且在HFrEF及HFpEF中的获益显示出一致性。对于目前尚无有效干预手段的2型糖尿病合并HFpEF患者来说,犹如带来一道希望的曙光。

基于CANVAS研究等CVOT结果,目前国内外心衰指南陆续推荐SGLT2抑制剂用于预防或延缓心衰相关结局(图2)。



图2. 国内外心衰指南:推荐SGLT2抑制剂用于预防或延缓心衰相关结局

考虑到SGLT2抑制剂在2型糖尿病合并心血管疾病治疗领域的重要作用,相信未来更多在心衰领域的研究将为此类药物提供更多指导!

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    2019-09-08 feather89
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    2019-11-28 jyzxjiangqin

    卡格列净降低心衰。

    0

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    2019-10-31 jyzxjiangqin

    卡格列净降低心衰事件风险。

    0

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    2019-07-03 bettycmoon
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