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在2型糖尿病中使用卡纳格利弗洛辛和选择性SGLT2抑制剂的心血管风险比较
Edy Kornelius1,2, Shih-Chang Lo2, Yi-Sun Yang1,2
1Chung Shan Medical University, School of Medicine, Taichung, Taiwan.
Frontiers in pharmacology
|November 5, 2025
概括
与选择性SGLT2抑制剂相比,双重SGLT1/2抑制剂Canagliflozin在2型糖尿病患者中显示了较高的重大心血管不良事件和死亡风险. 需要进一步的研究来证实这些现实世界的发现.
科学领域:
- 心血管医学 心血管医学
- 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:
- 卡纳格利弗洛辛对-葡萄糖共运输体 (SGLT) 1和2的双抑制可能会带来明显的代谢益处.
- 卡纳格利弗洛辛与选择性SGLT2抑制剂在现实环境中的心血管安全性比较尚未得到充分证实.
研究的目的:
- 为了比较卡纳格利弗洛辛和选择性SGLT2抑制剂之间主要不良心血管事件 (MACE) 和全因死亡率的风险.
- 在2型糖尿病患者中,研究双SGLT1/2抑制与选择性SGLT2抑制的心血管相关性.
主要方法:
- 这是一项回顾性队列研究,利用一个多中心的电子健康记录数据库,覆盖超过1.18亿名患者.
- 包括患有2型糖尿病的成年人和从2016年1月到2023年12月新使用SGLT抑制剂 (canagliflozin与其他SGLT2抑制剂) 的人.
- 24,078名患者的倾向性得分匹配 (1:1);MACE (心肌梗塞,中风,全因死亡率) 是主要结局.
主要成果:
- 与选择性SGLT2抑制剂相比,卡纳格里夫洛辛与MACE (HR,1.23;95% CI,1.14-1.33) 的风险显著增加有关.
- 与卡纳格利弗洛辛一起观察到,所有原因死亡率 (HR, 1.49; 95% CI, 1.33-1.68) 和出血性中风 (HR, 1.35; 95% CI, 1.02-1.79) 的风险较高.
- 缺血性中风和心肌梗塞的风险在两组之间相似.
结论:
- 启动卡纳格利弗洛辛与MACE和所有原因死亡率较高的观测事件率有关,在一个大型现实世界队列中.
- 这些发现是探索性的和产生假设的,由于观测设计,需要谨慎的解释.
- 需要进一步的研究来阐明在临床实践中SGLT2抑制剂之间心血管结果的潜在差异.
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