葡萄糖类1受体激动剂和心力衰竭:需要进一步的证据生成和实践指南优化
Muhammad Shahzeb Khan1, Gregg C Fonarow2, Darren K McGuire3
1Department of Medicine, Cook County Health Sciences, Chicago, IL (M.S.K.).
Circulation
|September 21, 2020
概括
对2型糖尿病 (T2DM) 和心力衰竭 (HF) 相关疾病需要最佳的治疗策略. -葡萄糖携带体2型抑制剂显示出一致的益处,而类似葡萄糖-1受体激动剂则需要对HF患者进行进一步的研究.
科学领域:
- 心脏病学
- 内分泌学
- 药理学
背景情况:
- 全球2型糖尿病 (T2DM) 和心力衰竭 (HF) 的发病率和流行率不断上升,需要优化治疗策略.
- 目前的指导方针建议高心血管风险的T2DM患者使用类似葡萄糖的-1受体激活剂 (GLP-1RA) 和-葡萄糖携带体2型抑制剂 (SGLT2is).
- 现有的建议往往缺乏关于HF预防与治疗的具体指导,并且没有区分HF表型.
研究的目的:
- 在T2DM和并发性HF患者中评估GLP-1RA和SGLT2is的疗效和安全性.
- 澄清这些药物类别在预防HF,治疗明显的HF以及解决不同HF表型 (减少射出分数的HF和保持射出分数的HF) 中的不同作用.
主要方法:
- 对SGLT2is和GLP-1RA的当前指导方针,共识陈述和心血管结局试验数据的审查.
- 对SGLT2的证据分析包括动脉样硬化心血管疾病和HF结局,包括DAPA- HF试验.
- 对GLP-1RA的机理性见解和试验观察结果的评估,涉及HF的结果和安全性.
主要成果:
- 无论T2DM状态如何,SGLT2对动脉样性心血管疾病和与HF相关的结局具有一致的益处,包括在HFrEF患者中.
- 尽管对T2DM和动脉样性心血管疾病的证据有限,但GLP-1RA建议用于T2DM和动脉样性心血管疾病,并越来越多地用于明显的高血压.
- 对于高频率的GLP-1RA的证据是不确定的,HFpEF的潜在益处是可见的,但HFrEF的安全性问题是可见的.
结论:
- 对于患有HF或处于HF风险的T2DM患者来说,SGLT2提供了成熟的好处,适用于HF表型.
- GLP-1RA在HF管理中的作用不太清楚,需要进一步研究,特别是关于HFrEF的安全性和HFpEF的疗效.
- 专门的临床试验至关重要,以确定这些药物的有效性,安全性和风险益处概况.
更多相关视频
相关概念视频
01:30Heart Failure V: Medical Management
124
Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
124
01:24Glucagon-like Receptor Agonists
673
Incretins include glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP), which stimulate insulin secretion post-meals. In type 2 diabetes, GIP's efficacy is reduced, making GLP-1 a viable drug target. GIP originates from preproGIP.
GLP-1, when administered in high doses intravenously, triggers insulin secretion, inhibits glucagon release, slows gastric emptying, reduces food intake, and restores normal insulin secretion. However, its rapid inactivation by...
GLP-1, when administered in high doses intravenously, triggers insulin secretion, inhibits glucagon release, slows gastric emptying, reduces food intake, and restores normal insulin secretion. However, its rapid inactivation by...
673
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
732
The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
732
01:26Heart Failure Drugs: Inotropic Agents
1.0K
Positive inotropic agents are commonly used as the first line of treatment for heart failure. One such agent is digoxin, derived from the genus Digitalis, which has been known for centuries but effectively utilized since 1785. However, these cardiac glycosides can have potentially toxic effects due to their mechanism of action, which involves inhibiting Na+/K+-ATPase and increasing contractility. Digoxin is absorbed orally and distributed in various tissues, including the CNS. It has a long...
1.0K
01:22Heart Failure VI: Adjunct Therapies
146
Additional therapies for treating patients with heart failure (HF) may include procedural interventions, supplemental oxygen, the management of sleep disorders, and nutritional therapy.Procedural InterventionsImplantable Cardioverter-Defibrillator: For patients at risk of life-threatening arrhythmias due to severe left ventricular dysfunction, an Implantable Cardioverter-Defibrillator (ICD) can detect and terminate these arrhythmias, preventing sudden cardiac death and improving survival rates.
146
01:29Heart Failure II: Pathophysiology
512
Systolic Heart Failure and Compensatory MechanismsSystolic heart failure (also termed HFrEF, Heart Failure with Reduced Ejection Fraction) is the most prevalent type of heart filure. It results in a decreased volume of blood being pumped from the ventricle. The aortic arch and carotid sinuses have baroreceptors that detect reduced blood pressure, triggering the sympathetic nervous system (SNS) to release epinephrine and norepinephrine. Initially, this response aims to boost heart rate and...
512