Cardiovascular and renal outcomes with SGLT2 inhibitors: Real-life observational studies in older patients with type 2 diabetes

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY

Accounts of Chemical Research Pub Date : 2023-04-01 DOI:10.1016/j.deman.2023.100135

André J. Scheen

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引用次数: 3

Abstract

Patients with type 2 diabetes mellitus (T2DM) are exposed to a high risk of atherosclerotic cardiovascular disease, heart failure and chronic kidney disease. The incidence of these complications increases markedly with the duration of diabetes and aging. Sodium-glucose cotransporter 2 inhibitors (SGLT2is) showed a remarkable reduction in hospitalization for heart failure and progression of kidney disease in large prospective placebo-controlled trials. Post hoc analyses of these trials demonstrated that cardiorenal protection occurred independently of age. The present comprehensive review analyzes the effects of SGLT2is on cardiovascular and renal outcomes among older patients with T2DM in cohort studies and real-life conditions. SGLT2is were associated with a significant reduction in hospitalization for heart failure (alone or combined with mortality) and in a composite renal outcome, including end-stage renal disease when compared to other oral glucose-lowering drugs, dipeptidyl peptidase-4 inhibitors and glucagon-like peptide-1 receptor agonists in patients aged ≥ 65 years and even ≥ 75 years. Several observational studies worldwide compared cardiorenal outcomes in people aged ≥ 65 years versus < 65 years and showed a similar relative benefit of SGLT2is in older versus younger patients with T2DM. These favourable results were obtained while the safety profile of SGLT2is in older patients was acceptable and almost comparable with that reported in younger patients. In conclusion, observational studies in real-life conditions confirm previous results reported in placebo-controlled trials and a positive benefit/risk balance in elderly patients with T2DM at risk of heart failure and chronic kidney disease.

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SGLT2抑制剂的心血管和肾脏预后:老年2型糖尿病患者的现实观察研究

2型糖尿病（T2DM）患者易患动脉粥样硬化性心血管疾病、心力衰竭和慢性肾脏疾病。这些并发症的发生率随着糖尿病和衰老的持续时间而显著增加。在大型前瞻性安慰剂对照试验中，钠-葡萄糖协同转运蛋白2抑制剂（SGLT2is）显著降低了心力衰竭和肾脏疾病进展的住院率。对这些试验的事后分析表明，心肾保护作用与年龄无关。本综述在队列研究和现实生活条件下分析了SGLT2is对老年T2DM患者心血管和肾脏预后的影响。在年龄≥65岁甚至≥75岁的患者中，与其他口服降糖药物、二肽基肽酶-4抑制剂和胰高血糖素样肽-1受体激动剂相比，SGLT2is与心力衰竭（单独或与死亡率联合）住院和复合肾结局（包括终末期肾病）显著减少有关。世界范围内的几项观察性研究比较了≥65岁与<；65岁，并且SGLT2is在老年和年轻T2DM患者中显示出相似的相对益处。获得了这些有利的结果，同时SGLT2is在老年患者中的安全性是可接受的，并且几乎与年轻患者中报告的安全性相当。总之，现实生活条件下的观察性研究证实了安慰剂对照试验中先前报道的结果，以及在有心力衰竭和慢性肾脏疾病风险的老年T2DM患者中的积极益处/风险平衡。

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.