新型循证疗法在心血管事件后2型糖尿病患者中的应用：来自CANHEART的见解

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open Pub Date : 2025-08-01 DOI:10.1016/j.cjco.2025.02.008

Wade Thompson PharmD, PhD , Brendan Wong MD , Atul Sivaswamy MSc , Laura Ferreira-Legere MScN , Douglas S. Lee MD, PhD , Husam Abdel-Qadir MD, PhD , Dennis T. Ko MD, MSc , Alanna Weisman MD, PhD , Sheldon Tobe MD, MSc , Cynthia A. Jackevicius PharmD, MSc , Shaun G. Goodman MD, MSc , Michael E. Farkouh MD , Jacob A. Udell MD, MPH

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引用次数: 0

摘要

背景：心血管（CV）住院治疗是实施指南导向药物治疗（GDMT）的开创性机会。钠-葡萄糖转运蛋白2抑制剂（SGLT2is）和胰高血糖素样肽-1受体激动剂（GLP1RAs）可以改善2型糖尿病（T2DM）和CV疾病患者的预后。方法：我们对2015年6月至2022年3月在安大略省因心血管事件（心肌梗死、心力衰竭、外周动脉疾病、缺血性卒中）住院的年龄≥66岁的T2DM患者进行了一项基于人群的队列研究，随访至2023年3月。我们检查了指数事件前后GDMT的使用情况，包括SGLT2is、GLP1RAs、他汀类药物和其他药物的使用情况。结果：75,869例年龄≥66岁的T2DM患者(中位年龄78岁；43%的女性)。住院前接受SGLT2is的比例为9%，随访期间为29%。GLP1RA在他汀类药物治疗前和治疗后分别为1%和9%，而他汀类药物治疗前和治疗后分别为65%和86%。新型GDMT的使用在随访期间有所增加。2016年，SGLT2i在住院后1年的使用率为4%，而2021年为39%；对于GLP1RA， 2016年的发病率为0%，而2021年为11%。结论新型GDMT使用的增加表明，在指数CV事件后，T2DM和CV疾病患者越来越多地采用优化二级预防的治疗方法。

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Uptake of novel evidence-based therapies in patients with type 2 diabetes after a cardiovascular event: insights from CANHEART

Background

A cardiovascular (CV) hospitalization is a seminal opportunity to implement guideline-directed medical therapy (GDMT). Sodium-glucose transporter 2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP1RAs) can improve outcomes among those with type 2 diabetes mellitus (T2DM) and CV disease.

Methods

We conducted a population-based cohort study among patients aged ≥ 66 years with T2DM in Ontario hospitalized for a CV event (myocardial infarction, heart failure, peripheral arterial disease, ischemic stroke) from June 2015 to March 2022, who were followed until March 2023. We examined use of GDMT before vs after the index event, including use of SGLT2is, GLP1RAs, statins, and others medications.

Results

We identified 75,869 people aged ≥ 66 years with T2DM (median age 78 years; 43% female). The proportion receiving SGLT2is was 9% before index hospitalization and 29% during the follow-up period. GLP1RA was used for 1% before vs 9% after, compared with 65% before and 86% after for statins. Use of novel GDMT increased across the follow-up period. The incidence of SGLT2i use 1-year posthospitalization was 4% in 2016 vs 39% in 2021; for GLP1RA use, the incidence was 0% in 2016 vs 11% in 2021.

Conclusions

A rise in the use of novel GDMT suggests increasing adoption of therapies to optimize secondary prevention in patients with T2DM and CV disease after index CV events.

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