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心血管疾患の後の2型糖尿病患者の新しい根拠に基づいた治療法の導入: CANHEARTからの洞察
Wade Thompson1,2,3,4, Brendan Wong5, Atul Sivaswamy2
1Women's College Research Institute, Toronto, Ontario, Canada.
CJC open
|September 2, 2025
まとめ
2型糖尿病 (T2DM) の高齢者において,ガイドライン指向医療療法 (GDMT) の使用は,ナトリウム・グルコーストランスポーター2阻害剤 (SGLT2is) とグルカゴン類ペプチド1受容体アゴニスト (GLP1RAs) を含め,心血管疾患の発生後に有意に増加した. これは より良い二次予防戦略が採用されていることを示しています
科学分野:
- 心臓病科
- 内分泌学
- 公衆衛生
背景:
- 心血管疾患 (CV) の入院は,ガイドライン指向の医療療法 (GDMT) を実施するための重要な窓を提供します.
- 2型糖尿病 (T2DM) と心血管疾患の患者のアウトカムを改善するために,ナトリウム・グルコーストランスポーター2阻害剤 (SGLT2is) とグルカゴン様ペプチド-1受容体アゴニスト (GLP1RAs) が有望である.
研究 の 目的:
- CVイベントの後にT2DMを持つ高齢者の間でGDMT,特にSGLT2isとGLP1RAの使用の傾向を評価する.
- 二次予防のための新しいGDMTの採用に対するCV入院の影響を評価する.
主な方法:
- カナダのオンタリオ州で集団ベースのコホート研究が行われました.
- 2015年6月から2022年3月までの間に心血管疾患で入院した66歳以上のT2DM患者も含まれています.
- インデックスCV入院前のおよび後のGDMT使用 (SGLT2is,GLP1RAs,スタチン) を調査し,2023年3月まで追跡調査した.
主要な成果:
- この研究では,75,869人の適格な患者を特定した.
- SGLT2の使用は入院前の9%から入院後の29%に増加し,GLP1RAの使用は1%から9%に増加しました.
- 入院後1年間のSGLT2i使用率は,2016年の4%から2021年の39%に増加し,GLP1RAの使用率は同じ期間に0%から11%に増加した.
結論:
- T2DMおよび心血管疾患の患者では,入院後のSGLT2isおよびGLP1RAを含む新しいGDMTの採用が顕著に増加しています.
- これらの発見は,この高リスク集団における二次予防戦略の改善を示唆しています.
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