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Lancet diabetes endo:钠-葡萄糖共转运体抑制剂与其他降糖药物治疗2型糖尿病患者时心血管意外的发生率和死亡率对比。

2017-08-04 qinqiyun MedSci原创

研究表明钠-葡萄糖共转运体-2(SGLT2)抑制剂empagliflozin(依帕列净)和canagliflozin(卡格列净)可降低心血管意外高风险的2型糖尿病患者心血管意外的发生率和死亡率。在广泛有心血管意外风险的人群中,SGLT2抑制剂的新使用患者和其他降糖药的新使用患者心血管意外的发生率和死亡率是否存在差异?

背景:研究表明钠-葡萄糖共转运体-2(SGLT2)抑制剂empagliflozin(依帕列净)和canagliflozin(卡格列净)可降低心血管意外高风险的2型糖尿病患者心血管意外的发生率和死亡率。Kare Birkeland及其同事利用临床实践中的真实数据,在广泛有心血管意外风险的人群中,比较SGLT2抑制剂的新使用患者和其他降糖药的新使用患者心血管意外的发生率和死亡率。

方法:募集2012年-2015年12月21日服用降糖药处方的患者,随机分为SGLT2抑制剂的新使用者和其他降糖药物的新使用者,比例为1:3(SGLT2抑制剂为1)。用Cox生存模型估算风险比(HRs),并计算加权平均数。研究的心血管结局是心血管死亡率,主要不良心血管事件(心血管死亡、心肌梗死、缺血性或出血热),心衰的医院事件(住院或门诊病人诊断为心衰),非致死性心肌梗死,非致死性中风和房颤。同时统计严重低血糖的发生率。

结果:SGLT2抑制剂组22830人,其他降糖药组68490人,平均随访0.9年(80669个病人年)、平均年龄61岁,40%是女性,心血管事件的发生率是25%(22686/91320)。研究中使用的SGLT2抑制剂94%是达格列净、5%是依帕列净、1%是卡格列净。与使用其他降糖药相比,SGLT2抑制剂可以降低心血管意外的风险(HR 0.53 [95% CI 0.40–0.71]), 主要不良心血管事件(0.78 [0.69–0.87]), 心衰的医院事件(0.70 [0.61–0.81];p<0.0001)。至于非致死性心肌梗死,非致死性中风和房颤的发生率则未见统计学差异。与使用其他降糖药相比,SGLT2抑制剂可降低严重低血糖的风险(HR 0.76 [0.65–0.90];p=0.001)。心血管意外的死亡率,差异接近于血管疾病患者的基础值——25%,而对本身没有心血管疾病的患者HR 0.60(0.42–0.85] 比0.55 (0.34–0.90)。有心血管疾病的患者与无心血管疾病的患者相比,主要不良心血管事件的HR是0.70(0.59-0.83)比0.90(0.76-1.07)。

分析:在心血管意外高风险的2型糖尿病患者人群中,与其他降糖药相比,SGLT2抑制剂可降低心血管疾病的发病率和死亡率。

原始出处:


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    2017-11-19 howi
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  5. 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status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1390260, encodeId=50a513902602c, content=<a href='/topic/show?id=355398180af' target=_blank style='color:#2F92EE;'>#降糖药物#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98180, encryptionId=355398180af, topicName=降糖药物)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bb182500058, createdName=yuhaisheng_ibp_32061711, createdTime=Sat Aug 05 23:41:00 CST 2017, time=2017-08-05, status=1, ipAttribution=)]
    2018-06-30 jklm09
  6. 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content=<a href='/topic/show?id=4066981e99e' target=_blank style='color:#2F92EE;'>#降糖药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98179, encryptionId=4066981e99e, topicName=降糖药)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b63894, createdName=minlingfeng, createdTime=Sat Aug 05 23:41:00 CST 2017, time=2017-08-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1383332, encodeId=5849138333278, content=<a href='/topic/show?id=196a1101f7' target=_blank style='color:#2F92EE;'>#2型糖尿病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1101, encryptionId=196a1101f7, topicName=2型糖尿病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ec19483, createdName=aids213, createdTime=Sat Aug 05 23:41:00 CST 2017, time=2017-08-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1390260, encodeId=50a513902602c, content=<a href='/topic/show?id=355398180af' target=_blank style='color:#2F92EE;'>#降糖药物#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98180, encryptionId=355398180af, topicName=降糖药物)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bb182500058, createdName=yuhaisheng_ibp_32061711, createdTime=Sat Aug 05 23:41:00 CST 2017, time=2017-08-05, status=1, ipAttribution=)]
    2017-11-24 yzh409
  8. 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createdName=ms9608593228839890, createdTime=Mon Aug 21 10:41:00 CST 2017, time=2017-08-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1760158, encodeId=4df81e6015817, content=<a href='/topic/show?id=9bea33520d' target=_blank style='color:#2F92EE;'>#BET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3352, encryptionId=9bea33520d, topicName=BET)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9a1a37427546, createdName=ms5439512287675881, createdTime=Sat Sep 16 04:41:00 CST 2017, time=2017-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1826375, encodeId=249118263e57f, content=<a href='/topic/show?id=e5283e89970' target=_blank style='color:#2F92EE;'>#发生率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37899, encryptionId=e5283e89970, topicName=发生率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30bd35, createdName=一叶知秋, createdTime=Mon Feb 12 10:41:00 CST 2018, time=2018-02-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1851500, encodeId=00671851500f7, content=<a href='/topic/show?id=f0a254918f0' target=_blank style='color:#2F92EE;'>#抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=92, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54918, encryptionId=f0a254918f0, topicName=抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=44a360, createdName=jklm09, createdTime=Sat Jun 30 23:41:00 CST 2018, time=2018-06-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1901745, encodeId=14191901e4558, content=<a href='/topic/show?id=c097591ed5' target=_blank style='color:#2F92EE;'>#Diabetes#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5917, encryptionId=c097591ed5, topicName=Diabetes)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0045169, createdName=木头人513, createdTime=Tue Dec 19 05:41:00 CST 2017, time=2017-12-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1696294, encodeId=1ba71696294ed, content=<a href='/topic/show?id=0107934e0a5' target=_blank style='color:#2F92EE;'>#转运#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=93470, encryptionId=0107934e0a5, topicName=转运)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=47c429881595, createdName=yzh409, createdTime=Fri Nov 24 07:41:00 CST 2017, time=2017-11-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1270860, encodeId=8a6c12e0860c4, content=<a href='/topic/show?id=4066981e99e' target=_blank style='color:#2F92EE;'>#降糖药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98179, encryptionId=4066981e99e, topicName=降糖药)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b63894, createdName=minlingfeng, createdTime=Sat Aug 05 23:41:00 CST 2017, time=2017-08-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1383332, encodeId=5849138333278, content=<a href='/topic/show?id=196a1101f7' target=_blank style='color:#2F92EE;'>#2型糖尿病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1101, encryptionId=196a1101f7, topicName=2型糖尿病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ec19483, createdName=aids213, createdTime=Sat Aug 05 23:41:00 CST 2017, time=2017-08-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1390260, encodeId=50a513902602c, content=<a href='/topic/show?id=355398180af' target=_blank style='color:#2F92EE;'>#降糖药物#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98180, encryptionId=355398180af, topicName=降糖药物)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bb182500058, createdName=yuhaisheng_ibp_32061711, createdTime=Sat Aug 05 23:41:00 CST 2017, time=2017-08-05, status=1, ipAttribution=)]
  9. 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  10. 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