Sieta T. de Vries, Michelle J. Pena, Sok Cin Tye, Sanne A. E. Peters, Daniël H. van Raalte, Clare Arnott, Adriaan A. Voors, Peter G. M. Mol, Petra Denig, Hiddo J. L. Heerspink
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The cardiovascular outcome was time to first event of a composite of stroke, myocardial infarction, cardiovascular death or hospitalisation for heart failure. Sex differences were assessed by a sex × treatment interaction term in Cox proportional hazards models.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Included were 1737 male participants and 924 female participants. The beneficial effect of angiotensin receptor blockers on the kidney outcome was similar between male and female participants (HR in male participants 0.72 [95% CI 0.59, 0.86] vs HR in female participants 0.86 [95% CI 0.69, 1.06]; sex × treatment interaction HR 1.19 [95% CI 0.89, 1.59]). For the cardiovascular outcome, angiotensin receptor blockers lowered the risk in male but not in female participants (HR in male participants 0.81 [95% CI 0.69, 0.95] vs HR in female participants 1.11 [95% CI 0.88, 1.40]; sex × treatment interaction HR 1.37 [95% CI 1.03, 1.82]).</p><h3 data-test=\"abstract-sub-heading\">Conclusions/interpretation</h3><p>This study in individuals with type 2 diabetes and diabetic kidney disease suggests that the beneficial effects of angiotensin receptor blockers are similar in male and female participants for the kidney outcome but not for the cardiovascular outcome. 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引用次数: 0
摘要
目的/假设我们的目的是评估血管紧张素受体阻滞剂（即氯沙坦和厄贝沙坦）对2型糖尿病和糖尿病肾病患者肾脏和心血管结局疗效的性别差异。方法采用血管紧张素II拮抗剂氯沙坦研究（RENAAL）和厄贝沙坦II型糖尿病肾病试验（IDNT）的数据。肾脏预后为首次发生终末期肾病或血清肌酐翻倍的时间。心血管终点为首次发生中风、心肌梗死、心血管死亡或因心力衰竭住院的时间。在Cox比例风险模型中，性别差异通过性别×治疗相互作用项进行评估。结果男性1737人，女性924人。血管紧张素受体阻滞剂对肾脏预后的有益作用在男性和女性参与者之间相似(男性参与者的HR为0.72 [95% CI 0.59, 0.86]，女性参与者的HR为0.86 [95% CI 0.69, 1.06]；性别与治疗相互作用的比值为1.19 [95% CI 0.89, 1.59])。对于心血管结局，血管紧张素受体阻滞剂降低了男性受试者的风险，但没有降低女性受试者的风险(男性受试者的HR为0.81 [95% CI 0.69, 0.95]，女性受试者的HR为1.11 [95% CI 0.88, 1.40]；性别与治疗相互作用的比值为1.37 [95% CI 1.03, 1.82])。结论/解释：这项针对2型糖尿病和糖尿病肾病患者的研究表明，在男性和女性受试者中，血管紧张素受体阻滞剂对肾脏结局的有益作用相似，但对心血管结局的有益作用不同。需要更多地关注血管紧张素受体阻滞剂疗效的性别差异和反应差异的潜在机制。临床试验注册：clinaltrials .gov nct00308347
Sex differences in the efficacy of angiotensin receptor blockers on kidney and cardiovascular outcomes among individuals with type 2 diabetes and diabetic kidney disease: post hoc analyses of the RENAAL and IDNT trials
Aims/hypothesis
Our aim was to assess sex differences in the efficacy of angiotensin receptor blockers (i.e. losartan and irbesartan) on kidney and cardiovascular outcomes in individuals with type 2 diabetes and diabetic kidney disease.
Methods
Data from the Angiotensin II Antagonist Losartan Study (RENAAL) and Irbesartan type II Diabetic Nephropathy Trial (IDNT) were used. The kidney outcome was time to first event of end-stage kidney disease or doubling of serum creatinine. The cardiovascular outcome was time to first event of a composite of stroke, myocardial infarction, cardiovascular death or hospitalisation for heart failure. Sex differences were assessed by a sex × treatment interaction term in Cox proportional hazards models.
Results
Included were 1737 male participants and 924 female participants. The beneficial effect of angiotensin receptor blockers on the kidney outcome was similar between male and female participants (HR in male participants 0.72 [95% CI 0.59, 0.86] vs HR in female participants 0.86 [95% CI 0.69, 1.06]; sex × treatment interaction HR 1.19 [95% CI 0.89, 1.59]). For the cardiovascular outcome, angiotensin receptor blockers lowered the risk in male but not in female participants (HR in male participants 0.81 [95% CI 0.69, 0.95] vs HR in female participants 1.11 [95% CI 0.88, 1.40]; sex × treatment interaction HR 1.37 [95% CI 1.03, 1.82]).
Conclusions/interpretation
This study in individuals with type 2 diabetes and diabetic kidney disease suggests that the beneficial effects of angiotensin receptor blockers are similar in male and female participants for the kidney outcome but not for the cardiovascular outcome. More attention to sex differences in angiotensin receptor blockers’ efficacy and underlying mechanisms of differences in response is needed.
期刊介绍：
Diabetologia, the authoritative journal dedicated to diabetes research, holds high visibility through society membership, libraries, and social media. As the official journal of the European Association for the Study of Diabetes, it is ranked in the top quartile of the 2019 JCR Impact Factors in the Endocrinology & Metabolism category. The journal boasts dedicated and expert editorial teams committed to supporting authors throughout the peer review process.
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