SGLT2i与糖尿病患者癌症治疗相关心功能障碍的一级预防

IF 12 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Jacc: Cardiooncology Pub Date : 2024-12-01 DOI:10.1016/j.jaccao.2024.08.001

Ammar W. Bhatti DO , Rushin Patel MD , Sourbha S. Dani MD , Sumanth Khadke MD , Bhargav Makwana MD , Candace Lessey MD , Jui Shah MD , Zaid Al-Husami MD , Eric H. Yang MD , Paaladinesh Thavendiranathan MD, SM , Tomas G. Neilan MD , Diego Sadler MD , Richard K. Cheng MD, MSc , Susan F. Dent MD , Jennifer Liu MD , Teresa Lopez-Fernandez MD , Joerg Herrmann MD , Marielle Scherrer-Crosbie MD, PhD , Daniel J. Lenihan MD , Salim S. Hayek MD , Sarju Ganatra MD

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引用次数: 0

摘要

背景：特定的癌症治疗可导致癌症治疗相关的心功能障碍（CTRCD）。钠葡萄糖共转运体-2抑制剂（SGLT2i）有可能预防这些心脏毒性效应：本研究旨在确定使用 SGLT2i 是否与 2 型糖尿病（T2DM）和癌症患者较低的 CTRCD 发生率有关：我们对 TriNetX 数据库中年龄≥18 岁、患有 T2DM、癌症、接触过心脏毒性抗肿瘤药物且无心肌病或心力衰竭病史记录的患者进行了回顾性分析。患者按使用 SGLT2i 进行分类。经过倾向评分匹配后，使用 Cox 比例 HRs 对 12 个月内的结果进行比较。研究还针对不同的癌症治疗类别进行了分组分析：该研究在每个队列中纳入了8675名倾向匹配患者（平均年龄=∼65岁，42%为女性，71%为白人，∼19%为胃肠道恶性肿瘤，∼25%为蒽环类药物）。服用 SGLT2is 的患者罹患 CTRCD 的风险较低（HR：0.76：95% CI：0.69-0.84）。SGLT2is 还降低了心衰加重（HR：0.81；95% CI：0.72-0.90）、全因死亡率（HR：0.67；95% CI：0.61-0.74）和全因住院/急诊就诊率（HR：0.93；95% CI：0.89-0.97）。亚组分析还显示，服用SGLT2i的患者接受各类癌症治疗的CTRCD风险降低：结论：服用 SGLT2i 可显著降低 T2DM 和癌症患者罹患 CTRCD 的风险。

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SGLT2i and Primary Prevention of Cancer Therapy–Related Cardiac Dysfunction in Patients With Diabetes

Background

Specific cancer treatments can lead to cancer therapy–related cardiac dysfunction (CTRCD). Sodium glucose cotransporter-2 inhibitors (SGLT2is) can potentially prevent these cardiotoxic effects.

Objectives

This study sought to determine whether SGLT2i use is associated with a lower incidence of CTRCD in patients with type 2 diabetes mellitus (T2DM) and cancer, exposed to potentially cardiotoxic antineoplastic agents, and without a prior documented history of cardiomyopathy or heart failure.

Methods

We conducted a retrospective analysis of patients aged ≥18 years within the TriNetX database with T2DM, cancer, exposure to cardiotoxic therapies, and no prior documented history of cardiomyopathy or heart failure. Patients were categorized by SGLT2i use. After propensity score matching, outcomes were compared over 12 months using Cox proportional HRs. Subgroup analyses focusing on different cancer therapy classes were performed.

Results

The study included 8,675 propensity-matched patients in each cohort (mean age = ∼65 years, 42% females, 71% White, ∼19% gastrointestinal malignancy, and ∼25% anthracyclines). Patients prescribed SGLT2is had a lower risk of developing CTRCD (HR: 0.76: 95% CI: 0.69-0.84). SGLT2is also reduced heart failure exacerbations (HR: 0.81; 95% CI: 0.72-0.90), all-cause mortality (HR: 0.67; 95% CI: 0.61-0.74), and all-cause hospitalizations/emergency department visits (HR: 0.93; 95% CI: 0.89-0.97). Subgroup analyses also demonstrated reduced CTRCD risk across various classes of cancer therapies in patients prescribed SGLT2is.

Conclusions

SGLT2i administration was associated with a significantly decreased risk of developing CTRCD in patients with T2DM and cancer.

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来源期刊

Jacc: Cardiooncology Multiple-

CiteScore

12.50

自引率

6.30%

发文量

106

期刊介绍： JACC: CardioOncology is a specialized journal that belongs to the esteemed Journal of the American College of Cardiology (JACC) family. Its purpose is to enhance cardiovascular care for cancer patients by publishing high-quality, innovative scientific research and sharing evidence-based knowledge. The journal aims to revolutionize the field of cardio-oncology and actively involve and educate professionals in both cardiovascular and oncology fields. It covers a wide range of topics including pre-clinical, translational, and clinical research, as well as best practices in cardio-oncology. Key areas of focus include understanding disease mechanisms, utilizing in vitro and in vivo models, exploring novel and traditional therapeutics (across Phase I-IV trials), studying epidemiology, employing precision medicine, and investigating primary and secondary prevention. Amyloidosis, cardiovascular risk factors, heart failure, and vascular disease are some examples of the disease states that are of particular interest to the journal. However, it welcomes research on other relevant conditions as well.