Antidiabetic combination therapy and cardiovascular outcomes:An evidence-based approach  

作　　者：Vanishri Ganakumar Cornelius J Fernandez Joseph M Pappachan 

机构地区：[1]Department of Endocrinology,Jawaharlal Nehru Medical College,Belagavi 590010,India [2]Department of Endocrinology and Metabolism,Pilgrim Hospital,United Lincolnshire Hospitals NHS Trust,Boston PE219QS,Lincolnshire,United Kingdom [3]Faculty of Science,Manchester Metropolitan University,Manchester M156BH,United Kingdom [4]Department of Endocrinology,KMC Medical College,Manipal Academy of Higher Education,Manipal 576104,India

出　　处：《World Journal of Diabetes》2025年第4期8-18,共11页世界糖尿病杂志(英文)

摘　　要：Type 2 diabetes mellitus is associated with a 2-4 times increased risk of cardiovascular(CV)disease.Glucagon-like polypeptide-1 receptor agonists(GLP1RA)and sodium-glucose cotransporter-2 inhibitors(SGLT2i)are two important classes of drugs with CV benefits independent of their antihyperglycemic efficacy.The CV outcome trials of both GLP1RA and SGLT2i have demonstrated CV superiority/neutrality concerning major adverse CV events(MACE).While GLP1RAs have exhibited a significant reduction in ischemic stroke and myocardial infarction(MI),SGLT2i have demonstrated a uniformly significant reduction in hospitalization for heart failure(HF)as a class effect.The unique clinical benefits and the distinct but complementary mechanisms of action make the combination of these drugs a mechanistically sound one.Recent meta-analyses suggest an independent and additive benefit of combination therapy of GLP1RA/SGLT2i vs monotherapy.Zhu et al,in a recent issue of the World Journal of Diabetes,demonstrates a numerically lower hazard ratio(HR)for CV outcomes with combination therapy vs monotherapy with either agent,with a reduction in MACE compared to GLP1RA alone[HR=0.51,95%confidence interval(CI):0.16-1.65],or SGLT2i alone(HR=0.48,95%CI:0.15-1.54).The CV death rate was also lower with combination therapy compared to GLP1RA alone(HR=0.58,95%CI:0.08-3.39),or SGLT2i alone(HR=0.55,95%CI:0.07-3.25).Fatal and non-fatal MI and fatal and non-fatal stroke were reduced with combination therapy compared to GLP1RA alone(HR=0.45,95%CI:0.10-2.18 and HR=0.86,95%CI:0.12-6.23,respectively),or SGLT2i alone(HR=0.44,95%CI:0.09-2.10 and HR=0.74,95%CI:0.10-5.47,respectively).Hospitalization for HF was prevented with combination therapy compared to GLP1RA alone(HR=0.26,95%CI:0.03-1.88),or SGLT2i alone(HR=0.33,95%CI:0.04-2.53).They also demonstrated that GLP1RA or SGLT2i monotherapy may not provide significant improvement in CV death and recurrent MI in patients with prior MI or HF,proposing a role for combination therapy in this subgroup.Appropriate patie

关 键 词：Glucagon-like polypeptide-1 receptor agonists Sodium-glucose cotransporter-2 inhibitors Cardiovascular disease Type 2 diabetes mellitus Cardiovascular outcome trials 

分 类 号：R587.1[医药卫生—内分泌]