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卡纳格里弗洛辛用于心血管事件的初级和次级预防:CANVAS计划的结果 (卡纳格里弗洛辛心血管评估研究)
Kenneth W Mahaffey1, Bruce Neal2,3,4,5, Vlado Perkovic2,6
1Department of Medicine, Stanford Center for Clinical Research, Stanford University School of Medicine, CA (K.W.M.) kenneth.mahaffey@stanford.edu.
Circulation
|November 15, 2017
概括
在2型糖尿病患者中,卡纳格里夫洛辛显著降低了心血管事件,不论他们是否有心血管疾病史. 这种药物在初级和二级预防组中显示出一致的益处,在减少主要心血管不良事件方面显示出有效性.
科学领域:
- 心脏病学
- 内分泌学
- 药理学
背景情况:
- 卡纳格里弗洛辛是一种糖携带体2抑制剂,用于2型糖尿病患者心血管风险较高.
- 在CANVAS计划中评估了卡纳格利弗洛辛的心血管效应,比较了先前患有心血管疾病和没有心血管疾病的患者的结果 (二次预防与初级预防).
研究的目的:
- 评估卡纳格利弗洛辛在减少心血管死亡,非致命心肌梗塞或非致命中风的综合效果.
- 在初级和二级预防队列中比较卡纳格里夫洛辛的治疗效果.
主要方法:
- 在CANVAS计划中,有10,142名2型糖尿病患者随机接受卡纳格里夫洛辛或安慰剂治疗.
- 参与者分为初级预防 (≥50年,≥2个风险因素,没有先前的事件) 和二次预防 (≥30年,先前的事件) 队列.
- 主要终点是主要心血管不良事件的组合;次要终点包括心力衰竭住院和事件.
主要成果:
- 主要终点事件发生率在二次预防组 (36. 9/1000患者年) 较于初级预防组 (15. 7/1000患者年) 较高.
- 卡纳格里弗洛辛降低了总队列中的初级终点 (HR,0. 86;P=0. 02对于优势) 在初级 (HR,0. 98) 和二级 (HR,0. 82) 预防组之间没有显著的异质性.
- 在这两组患者中,脏结局和心力衰竭住院的病例同样减少,而下肢截肢的病例同样增加.
结论:
- 患有2型糖尿病和先前心血管事件的患者心血管结局率较高.
- 在初级和二级预防组中,卡纳格里弗洛辛有效地降低了心血管和结局,治疗效果没有显著的异质性.
- 需要进一步研究以充分了解卡纳格里夫洛辛在这些不同患者群体中的作用.
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