二肽基肽酶IV抑制剂会增加心力衰竭的风险吗?心脏病专家的悖论

R. Kanakia, S. Martinho, T. Patel, F. A. Arain, Manoj Panday, C. J. Saux, S. Pham, S. Bailey, R. Chilton
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引用次数: 2

摘要

与普通人群相比,糖尿病患者的心血管疾病负担更高。此外,2型糖尿病预示着发生主要不良心血管事件的风险非常高。SAVOR试验显示,有2型糖尿病病史和既往心血管疾病病史或危险因素的患者1年心血管事件发生率为2 - 3%。而在EXAMINE试验中,2型糖尿病合并急性冠状动脉综合征患者在血运重建术后的1年事件发生率在6 - 7%之间。这两项前瞻性试验都使用新的二肽基肽酶IV (DPP-4)抑制剂作为治疗方式。在临床上,这类化合物对患者的耐受性非常好。从之前的荟萃分析来看,新的DPP-4抑制剂在降低心血管预后方面很有希望。在这篇文章中,我们回顾了关于口服降糖药的心血管结局的文献,重点是最近两项关于DDP-4抑制剂的大型前瞻性试验。重要的是要认识到这些试验纳入了不同的患者。在SAVOR试验中,2型糖尿病患者(> 40岁)有明确的心血管疾病或多种心血管危险因素,而在EXAMINE试验中,2型糖尿病患者(> 18岁)在急性冠状动脉综合征血管化术后15 - 90天。主要心血管终点为心血管死亡、非致死性心肌梗死或非致死性卒中的复合终点。两项试验均未显示出显著的心血管益处。然而,两项试验均未显示心血管疾病死亡率增加。心血管内分泌3:111 - 116©2014沃尔特斯威尔金斯。中华心血管病杂志,2014,(3):111 - 116
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Does dipeptidyl peptidase IV inhibitor increase the risk of heart failure? A cardiologist's paradox
Diabetes patients have a higher burden of cardiovascular disease compared with the general population. In addition, type 2 diabetes portends a very high risk for major adverse cardiovascular events. The SAVOR trial showed that patients with documented type 2 diabetes and a previous history of, or risk factors for, cardiovascular disease had a 1-year cardiovascular event rate of 2 – 3%. Whereas in the EXAMINE trial, type 2 diabetes patients with acute coronary syndrome had a 1-year event rate between 6 and 7% after revascularization. Both of these prospective trials used new dipeptidyl peptidase IV (DPP-4) inhibitors as the treatment modality. Clinically, this class of compounds is extremely well tolerated by patients. The new DPP-4 inhibitors were promising from previous meta-analyses at reducing cardiovascular outcomes. In this article, we review literature on the cardiovascular outcomes with oral hypoglycemic agents, focusing on the two recent, large prospective trials on DDP-4 inhibitors. It is important to recognize that these trials enrolled different patients. The SAVOR trial had type 2 diabetes patients ( > 40 years old) with established cardiovascular disease or multiple cardiovascular risk factors, whereas EXAMINE trial had type 2 diabetes patients ( > 18 years old) 15 – 90 days postrevascularization for acute coronary syndrome. The primary cardiovascular endpoint was a composite of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke. Neither trial showed a significant cardiovascular benefit. However, neither trial showed increased cardiovascular mortality. Cardiovasc Endocrinol 3:111 – 116 © 2014 Wolters Wilkins. Cardiovascular Endocrinology 2014, 3: 111 – 116
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