Cardiometabolic and renal benefits of sodium–glucose cotransporter 2 inhibitors

IF 40 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM
Yong-ho Lee, Soo Lim, Melanie J. Davies
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引用次数: 0

Abstract

The therapeutic scope of sodium–glucose cotransporter 2 (SGLT2) inhibitors has expanded beyond glycaemic regulation in the management of diabetes mellitus. Studies published in the past few years highlight their substantial effect on cardiovascular outcomes, notably in decreasing mortality and the need for heart failure-related hospitalization. These agents also lead to pronounced improvements in a range of renal outcomes. The primary actions of SGLT2 inhibition, glycosuria and natriuresis, are pivotal in enhancing glucose control, promoting weight loss and lowering blood pressure. These effects initiate a series of beneficial mechanisms: facilitating haemodynamic improvement by reducing interstitial volume, enhancing cardiac function, boosting energy efficiency through altered ketone body metabolism and mitigating inflammation and oxidative stress. Additional effects include heightened erythropoiesis, reduced hyperuricaemia and increased levels of angiotensin-converting enzyme 2 and angiotensin (1–7). SGLT2 inhibitors also attenuate sympathetic overactivity by modulating neurohumoral activation and renal afferent signalling, contributing to their cardioprotective and renoprotective profiles. This Review provides a comprehensive overview of the diverse mechanisms underpinning the cardiometabolic and renal effects of SGLT2 inhibitors, emphasizing their clinical relevance and therapeutic potential.

Abstract Image

钠-葡萄糖共转运蛋白2抑制剂对心脏代谢和肾脏的益处
钠-葡萄糖共转运蛋白2 (SGLT2)抑制剂的治疗范围已经扩展到糖尿病管理中的血糖调节。过去几年发表的研究强调了它们对心血管预后的重大影响,特别是在降低死亡率和心力衰竭相关住院治疗方面。这些药物还能显著改善一系列肾脏预后。SGLT2抑制的主要作用是糖尿和尿钠,在加强血糖控制、促进体重减轻和降低血压中起关键作用。这些作用启动了一系列有益的机制:通过减少间质体积促进血流动力学改善,增强心功能,通过改变酮体代谢提高能量效率,减轻炎症和氧化应激。其他作用包括红细胞生成能力增强,高尿酸血症减少,血管紧张素转换酶2和血管紧张素水平升高(1-7)。SGLT2抑制剂还通过调节神经体液激活和肾传入信号来减弱交感神经过度活跃,从而促进其心脏保护和肾保护作用。本综述全面概述了SGLT2抑制剂对心脏代谢和肾脏影响的多种机制,强调了其临床相关性和治疗潜力。
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来源期刊
Nature Reviews Endocrinology
Nature Reviews Endocrinology 医学-内分泌学与代谢
CiteScore
42.00
自引率
0.70%
发文量
158
审稿时长
6-12 weeks
期刊介绍: Nature Reviews Endocrinology aspires to be the foremost platform for reviews and commentaries catering to the scientific communities it serves. The journal aims to publish articles characterized by authority, accessibility, and clarity, enhanced with easily understandable figures, tables, and other visual aids. The goal is to offer an unparalleled service to authors, referees, and readers, striving to maximize the usefulness and impact of each article. Nature Reviews Endocrinology publishes Research Highlights, Comments, News & Views, Reviews, Consensus Statements, and Perspectives relevant to researchers and clinicians in the fields of endocrinology and metabolism. Its broad scope ensures that the work it publishes reaches the widest possible audience.
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