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糖尿病和慢性病中的心血管疾病
Sowmya Swamy1, Sahibzadi Mahrukh Noor2, Roy O Mathew2,3
1Department of Medicine, School of Medicine, George Washington University, Washington, DC 20052, USA.
Journal of clinical medicine
|November 25, 2023
概括
管理糖尿病 (DM) 和慢性病 (CKD) 是降低心血管疾病 (CVD) 风险的关键. 像SGLT2抑制剂和GLP1受体激动剂这样的新疗法在改善这些患者的治疗结果方面显示出显著的希望.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 心脏病学 心脏病学
- 内分泌学 在内分泌学.
背景情况:
- 糖尿病病 (DKD) 影响40%的糖尿病患者,显著增加心血管疾病 (CVD) 风险.
- 慢性病 (CKD) 作为DM患者心血管疾病风险的关键调解者.
- 有证据表明,与没有CKD的糖尿病患者相比,患CKD的糖尿病患者的心血管疾病发病率更高.
研究的目的:
- 审查当前关于在DM患者中管理CKD以减轻心血管疾病风险的证据.
- 要突出血糖控制,胺-血管酶系统抑制 (RASI),SGLT2抑制剂 (SGLT2i) 和GLP1受体激动剂 (GLP1RA) 在DKD和CVD预防中的作用.
- 讨论未来的DM,CKD和CVD共患病的管理方向.
主要方法:
- 对多个心血管疾病结局试验和确立证据的审查.
- 分析血压控制,血糖控制和RASI对CKD发展和进展的影响.
- 对SGLT2i和GLP1RA在患有和没有CKD的患者中的最新数据的评估.
主要成果:
- 血糖控制证明了预防DM中CKD发展的最有力的证据.
- 拉西在减缓CKD进展方面是有效的,特别是在白蛋白尿的情况下.
- 在DM患者中,SGLT2i和GLP1RA显著降低了死亡率,心力衰竭住院和CKD恶化,无论是否存在CKD.
结论:
- 优化血糖控制是预防糖尿病中CKD的关键.
- 对于已建立的CKD管理,RASI仍然很重要.
- SGLT2i和GLP1RA代表着一个范式的转变,为糖尿病和慢性病患者的心血管和结局提供了巨大的好处.
- 未来的研究重点是组合疗法,有望进一步减少心血管疾病事件.
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