对心脏衰竭患者的肥胖和减肥策略
Amanda R Vest1, Philip R Schauer2, Jo E Rodgers3
1Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Kaufman Center for Heart Failure Treatment and Recovery, Cleveland Clinic, Cleveland, Ohio, USA.
JACC. Heart failure
|August 2, 2024
概括
肥胖在心力衰竭患者中很常见. 像GLP-1激动剂这样的新型减肥药物对心力衰竭有保存在喷射分数 (HFpEF) 的治疗有希望,提高了安全性和有效性.
科学领域:
- 心脏病学 心脏病学
- 内分泌学 在内分泌学.
- 代谢疾病 代谢疾病
背景情况:
- 肥胖是心力衰竭中常见的并发症,其中包括心力衰竭与减少喷射率 (HFrEF) 和心力衰竭与保存喷射率 (HFpEF).
- 肥胖和HFpEF之间的病理生理联系特别强烈.
- 目前的心力衰竭患者减肥的生活方式干预措施面临可持续性挑战,有效性数据有限.
研究的目的:
- 评估减肥手术和抗肥胖药物在心力衰竭患者肥胖管理中的作用.
- 在心力衰竭的背景下,评估较新的抗肥胖药物,特别是GLP-1激动剂的安全性和有效性.
主要方法:
- 对手术前心力衰竭或左心室功能障碍患者的减肥手术现有数据的综述.
- 来自GLP-1和胃抑制多/GLP-1激动剂的一般人群试验的安全性和有效性数据的分析.
- 检查涉及GLP-1agonistsemaglutide在HFpEF患者肥胖治疗中的试验.
主要成果:
- 腹腔外科手术表现出适度的疗效和安全性,与心力衰竭住院减少和中期死亡率相关.
- 抗肥胖药物,特别是GLP-1激动剂,显示出令人鼓舞的安全性和减肥有效性.
- 塞马格卢提德试验证实了HFpEF患者的安全性和有效性,尽管在高级HFrEF中存在一些担忧.
结论:
- 虽然减肥手术有好处,但新的抗肥胖药物,如GLP-1激动剂,为心力衰竭中的肥胖提供了有希望的治疗途径.
- GLP-1激动剂,特别是塞马格卢提德,在高度肥胖患者的肥胖管理中是安全有效的.
- 进一步的研究是有必要的,以充分了解这些药物的长期心血管影响和最佳使用在整个心力衰竭的频谱.
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