在心力衰竭中使用-葡萄糖共运输体-2 抑制剂的时间和坚持问题
Mehmet Birhan Yilmaz1, Ahmet Celik2, Anil Sahin3
1Department of Cardiology, Faculty of Medicine Dokuz Eylül University Izmir Turkey.
Journal of the American Heart Association
|March 21, 2025
概括
-葡萄糖携带载体-2 抑制剂 (SGLT-2is) 在心力衰竭 (HF) 和糖尿病患者中显著减少全因死亡. 在HF诊断之前的早期处方和对SGLT-2的良好遵守与最大的生存益处有关.
科学领域:
- 心脏病学 心脏病学
- 内分泌学 在内分泌学.
- 药理学 药理学是指药理学的学科.
背景情况:
- -葡萄糖携带载体-2 抑制剂 (SGLT-2is) 对于控制糖尿病至关重要,即使在心力衰竭 (HF) 患者中也是如此.
- 与HF诊断相比,SGLT-2i启动的时间和患者的坚持是优化结果的关键因素.
研究的目的:
- 调查SGLT-2i时间 (HF诊断前与后) 对糖尿病HF患者死亡率的影响.
- 评估SGLT-2i遵守 (覆盖日数的比例) 对这一群体的生存的影响.
主要方法:
- 来自TRends-HF注册表的大量HF和糖尿病患者队列的回顾性分析.
- 患者根据SGLT-2i处方时间和坚持 (覆盖日数的比例) 并与非使用者进行分类.
主要成果:
- 糖尿病HF患者在HF诊断之前处方SGLT-2is的预后最为有利,特别是暴露时间较长 (中位数为417天).
- 在使用SGLT-2is诊断HF后的患者中,不良坚持 (例如,覆盖日数比例下降>10%) 与全因死亡率增加59%有关.
结论:
- 对于患有HF和糖尿病的患者来说,SGLT-2is提供了显著的全因死亡率益处,无论是否坚持或时间.
- 当SGLT-2is在指数HF诊断之前启动时,观察到最大的生存优势.
- 对SGLT-2的低于最佳的坚持是HF后的诊断,与更糟糕的生存结果有关.
相关概念视频
01:26Heart Failure Drugs: Inotropic Agents
479
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...
479
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
356
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...
356
01:22Heart Failure Drugs: Diuretics
312
Heart failure and kidney perfusion are interconnected in a complex way. Reduced renal perfusion and venous congestion are two significant factors that contribute to renal dysfunction in heart failure. The kidneys, primarily responsible for fluid balance in the body, are adversely affected due to compromised cardiac output and increased venous pressure. In response to reduced renal perfusion, the kidneys activate neurohumoral mechanisms to restore balance. However, these mechanisms can be...
312
01:22Heart Failure Drugs: β-Blockers
299
β-adrenergic antagonists, commonly known as β-blockers, block the effects of sympathetic neurotransmitters such as noradrenaline (NA) and adrenaline (ADR). They have several beneficial effects in heart failure treatment. They reduce heart rate, the force of contraction, and cardiac muscle relaxation. They also slow the atrial-ventricular conduction rate and raise the threshold for arrhythmias. The concentration of β-blockers determines their effects on bronchodilation,...
299
01:22Antiarrhythmic Drugs: Class I Agents as Sodium Channel Blockers
1.1K
Class I antiarrhythmic drugs are used to treat various types of arrhythmias or irregular heart rhythms. These drugs block the sodium (Na+) channels in the cardiac cells, thereby affecting the movement of electrical impulses across the heart. Class I antiarrhythmic drugs are divided into three subgroups: Class IA, Class IB, and Class IC, each with distinct mechanisms of action and effects on the heart.
Class 1A Antiarrhythmic Drugs: These drugs work by moderately blocking sodium channels,...
Class 1A Antiarrhythmic Drugs: These drugs work by moderately blocking sodium channels,...
1.1K
01:33Hormonal Regulation
32.8K
The renin-aldosterone system is an endocrine system which guides the renal absorption of water and electrolytes, thus managing blood pressure and osmoregulation. Activation of the system begins in the kidneys with a small cluster of cells adjacent to the afferent and efferent blood vessels of the renal corpuscle. As the nephrons are filtering blood, juxtaglomerular cells monitor blood pressure. If they detect a decrease in pressure, they release the hormone renin into the bloodstream.
32.8K