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2型糖尿病における心血管および腎臓のアウトカムの第一および二次予防のためのSGLT2阻害剤:心血管アウトカムの試験の体系的レビューおよびメタ解析
Thomas A Zelniker1, Stephen D Wiviott1, Itamar Raz2
1TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA.
Lancet (London, England)
|November 15, 2018
まとめ
ナトリウム・グルコース・コトランスポーター2阻害剤 (SGLT2i) は,既発性動脈硬化症の患者に適度な心血管上の利点を提供します. 2型糖尿病患者の心臓不全の入院を大幅に減らし,腎臓病の進行を遅らせます.
科学分野:
- 心臓病科
- 腎臓科
- 薬理学について
背景:
- SGLT2阻害剤 (SGLT2i) の心臓血管および腎臓に対する正確な効果と,患者の特徴に基づくその変動性は完全に理解されていません.
- 2型糖尿病患者は心血管や腎臓の合併症のリスクが高い.
研究 の 目的:
- 主要な心血管疾患,心不全の入院,腎疾患の進行に対するSGLT2iの効果を体系的に評価する.
- SGLT2iの有効性は,動脈硬化性心血管疾患,心不全歴,腎臓機能などの患者基準によって変化するかどうかを判断する.
主な方法:
- 2型糖尿病患者のSGLT2iのランダム化,プラセボ対照の心臓血管結果試験の体系的なレビューとメタ解析.
- 2018年9月24日までのPubMedとEmbaseのデータベースで検索した.
- 効果の結果と,ベースラインの特徴による分層分析の危険比率をまとめました.
主要な成果:
- 主に動脈硬化性心血管疾患の患者で,SGLT2iは主要な心血管疾患を11% (HR 0. 89) 減少させた.
- 心血管疾患または心不全歴に関係なく,心血管疾患による死亡または心不全による入院の有意な23%の減少 (HR 0. 77) が観察されました.
- SGLT2iは腎疾患の進行を45%減少させ (HR0. 55) した.
結論:
- SGLT2iは,動脈硬化性心血管疾患または心不全歴に関係なく,2型糖尿病患者の心不全入院を減少させ,腎疾患の進行を遅らせることに有意な利点をもたらします.
- 主要な心血管不良に関する心血管上の利益は,既にある動脈硬化性心血管疾患の患者に集中しているようです.
- SGLT2iの心臓機能不全と腎臓のアウトカムに対する有効性は,出血時の腎臓機能に影響されます.
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