SGLT2i对HFpEF患者心脏代谢的影响:事实还是虚构?

IF 8.5 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Francesca Cinti, Renzo Laborante, Luigi Cappannoli, Cassandra Morciano, Shawn Gugliandolo, Alfredo Pontecorvi, Francesco Burzotta, Maria Donniacuo, Donato Cappetta, Giuseppe Patti, Andrea Giaccari, Domenico D'Amario
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引用次数: 0

摘要

2型糖尿病(T2D)患病率的上升与心血管疾病发病率的增加密切相关,特别是保留射血分数的心力衰竭(HFpEF)。t2dm的心脏代谢紊乱,如胰岛素抵抗、高血糖和血脂异常,会导致微血管和大血管并发症,从而增加心力衰竭的风险。钠-葡萄糖共转运蛋白-2抑制剂(SGLT2i)最初是作为T2D的降血糖药物开发的,已经证明对心力衰竭患者(包括保留射血分数(HFpEF)的患者)有很好的心血管益处,无论T2D状态如何。这些益处包括降低心力衰竭住院率和改善各种代谢参数。本综述旨在严格检查SGLT2i对HFpEF患者心脏代谢的影响,评估观察到的益处是否可以真正归因于它们对心肌能量调节的影响,或者它们是否代表其他可能混淆的机制。我们将重点关注SGLT2i可能调节的关键代谢过程,包括心肌葡萄糖利用、脂肪酸氧化和线粒体功能,并探讨它们对心力衰竭病理生理的影响。此外,我们将探讨SGLT2i在HFpEF相关的其他致病因素中的作用,如钠和体液平衡、炎症和纤维化,并质疑这些机制在多大程度上有助于观察到的临床益处。通过综合目前的证据,本综述将对SGLT2i影响HFpEF患者心脏代谢的机制进行深入分析,评估其作用是否有可靠的科学数据支持或仍然是推测性的。我们还将讨论基于个体患者特征的个性化治疗策略的潜力,以优化SGLT2i在控制T2D和心血管风险方面的治疗益处。本综述旨在阐明SGLT2i在心血管代谢疾病和HFpEF治疗中的真正临床应用,并深入了解其在改善长期心血管预后方面的作用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The effects of SGLT2i on cardiac metabolism in patients with HFpEF: Fact or fiction?

The rising prevalence of Type 2 diabetes (T2D) has been closely associated with an increased incidence of cardiovascular diseases, particularly heart failure with preserved ejection fraction (HFpEF). Cardiometabolic disturbances in T2D, such as insulin resistance, hyperglycemia, and dyslipidemia, contribute to both microvascular and macrovascular complications, thereby intensifying the risk of heart failure. Sodium-glucose cotransporter-2 inhibitors (SGLT2i), initially developed as glucose-lowering agents for T2D, have demonstrated promising cardiovascular benefits in patients with heart failure, including those with preserved ejection fraction (HFpEF), regardless of T2D status. These benefits include reduced heart failure hospitalization rates and improvements in various metabolic parameters. This review aims to critically examine the effects of SGLT2i on cardiac metabolism in HFpEF, evaluating whether the observed benefits can truly be attributed to their impact on myocardial energy regulation or whether they represent other, potentially confounding, mechanisms. We will focus on the key metabolic processes possibly modulated by SGLT2i, including myocardial glucose utilization, fatty acid oxidation, and mitochondrial function, and explore their effects on heart failure pathophysiology. Additionally, we will address the role of SGLT2i in other pathogenetic factors involved in HFpEF, such as sodium and fluid balance, inflammation, and fibrosis, and question the extent to which these mechanisms contribute to the observed clinical benefits. By synthesizing the current evidence, this review will provide an in-depth analysis of the mechanisms through which SGLT2i may influence cardiac metabolism in HFpEF, assessing whether their effects are supported by robust scientific data or remain speculative. We will also discuss the potential for personalized treatment strategies, based on individual patient characteristics, to optimize the therapeutic benefits of SGLT2i in managing both T2D and cardiovascular risk. This review seeks to clarify the true clinical utility of SGLT2i in the management of cardiometabolic diseases and HFpEF, offering insights into their role in improving long-term cardiovascular outcomes.

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来源期刊
Cardiovascular Diabetology
Cardiovascular Diabetology 医学-内分泌学与代谢
CiteScore
12.30
自引率
15.10%
发文量
240
审稿时长
1 months
期刊介绍: Cardiovascular Diabetology is a journal that welcomes manuscripts exploring various aspects of the relationship between diabetes, cardiovascular health, and the metabolic syndrome. We invite submissions related to clinical studies, genetic investigations, experimental research, pharmacological studies, epidemiological analyses, and molecular biology research in this field.
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