在2型糖尿病中,将新一代GLP-1RA添加到SGLT2i的实际有效性
Nathorn Chaiyakunapruk1,2, Xi Tan3, Yuanjie Liang3
1Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, UT, USA.
Cardiovascular diabetology
|April 24, 2025
概括
与葡萄糖类-1受体激动剂 (GLP-1RAs) 和-葡萄糖共传输体2抑制剂 (SGLT2is) 的联合治疗显著降低了2型糖尿病 (T2D) 的心脏病风险. 与单独使用SGLT2is相比,这种组合疗法显示出添加性心脏保护益处.
科学领域:
- 心脏病学 心脏病学
- 内分泌学 在内分泌学.
- 腎臟病學 (nephrology) 是一種醫學專業.
背景情况:
- 目前的指导方针建议将葡萄糖类-1受体激动剂 (GLP-1RAs) 与-葡萄糖共传输体2抑制剂 (SGLT2is) 结合起来,用于管理2型糖尿病 (T2D) 和降低心脏病风险.
- 关于这种联合治疗的长期心脏代谢和的影响,现实世界数据有限.
研究的目的:
- 评估新一代GLP-1RAs与SGLT2is相结合的心血管 (CV),代谢和结局,而SGLT2is仅用于T2D患者.
- 评估这些药物类别对心脏代谢和脏健康的附加效应.
主要方法:
- 一项回顾性队列研究分析了2017年1月至2023年6月的美国成人数据,其中包括超过10万接受组合治疗的患者和超过339,000仅接受SGLT2i的患者.
- 患者被分为三个队伍:T2D与动脉样性心血管疾病 (ASCVD),T2D和T2D与慢性病 (CKD).
- 结果包括主要不良心血管事件 (MACE),糖化血红蛋白 (HbA1c) 变化和体重减轻的时间到事件.
主要成果:
- 在ASCVD队列中,组合疗法与单独使用SGLT2i相比,与缺血性中风 (42%),心肌梗塞 (37%) 和MACE (46%为3分,45%为5分) 的风险显著降低.
- 特定的GLP-1RAs,特别是每周一次的塞马格卢提德,与SGLT2is结合,表明CV风险,HbA1c和体重的最大降低.
- 组合疗法导致心脏代谢结果明显好于SGLT2i单一疗法.
结论:
- 与单独使用SGLT2抑制剂相比,结合SGLT2抑制剂和GLP-1受体激活剂可以获得更好的心脏代谢结果.
- 这些发现支持了GLP-1RAs和SGLT2is的心脏保护作用是附加性的假设,加强了它们在T2D管理中的联合使用.
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