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2型糖尿病における心不全と死亡率に対するダパグリフロジンの効果

Eri T Kato1, Michael G Silverman2, Ofri Mosenzon3

  • 1Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Japan (E.T.K.).

Circulation
|March 19, 2019
PubMed
まとめ

ダパグリフロジンは,ナトリウム・グルコース・コトランスポーター2阻害剤で,2型糖尿病および心不全の患者に有益です. ダパグリフロジンは,すべての患者で心不全の入院を減少させ,エジェクション分数が減少した患者で心血管疾患による死亡と死亡率を改善しました.

キーワード:
糖尿病 糖尿病心不全死亡率ナトリウム・グルコース・トランスポーター2阻害剤

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科学分野:

  • 心臓病科
  • 内分泌学
  • 薬理学について

背景:

  • DECLARE- TIMI 58試験では,2型糖尿病患者のダパグリフロジンについて調査した.
  • SGLT2阻害剤は心臓血管に有益である.
  • SGLT2阻害剤の効果に対するエジェクション分数の影響は,以前は知られていなかった.

研究 の 目的:

  • 2型糖尿病患者におけるダパグリフロジンの臨床効果に対する基値左心室射出分数の効果を評価する.
  • 異なるEF層における心臓血管死亡と心臓不全入院 (HHF) の減少におけるダパグリフロジンの有効性を評価する.
  • すべての原因による死亡率に対するダパグリフロジンの影響をEFに基づいて分析する.

主な方法:

  • 基礎心不全 (HF) 状態とEFを含むDECLARE- TIMI 58試験データの分析
  • 減少したEF (HFrEF,EF < 45%),減少したEFのないHF,およびHFの歴のないHFに分類された患者.
  • 主なアウトカムには,心血管疾患による死亡/HHF,その構成要素,および全因死亡率の複合が含まれていた.

主要な成果:

  • ダパグリフロジンは,HFrEFのない患者と比較して,HFrEF (HR 0. 88; P相互作用=0. 046) を有意に減少させた.
  • HFrEFとHFrEF以外のグループにおいて,ダパグリフロジンによって心臓不全入院 (HHF) が減少した.
  • HFrEF (P相互作用 < 0. 02) の患者においてのみ,ダパグリフロジンは心血管疾患による死亡と全因死亡率を有意に減少させた.

結論:

  • ダパグリフロジンは,2型糖尿病の患者,特にHFrEFの患者で臨床的に有意義な効果を示しています.
  • この研究は,EFに基づくダパグリフロジンの影響の差異を強調し,特別の治療アプローチを提案しています.
  • ダパグリフロジンによるSGLT2抑制は,EFスペクトル全体でHHFを減少させ,HFrEF患者の死亡率を改善します.