SGLT2 抑制剂--在心力衰竭治疗中发挥重要作用

Karol Wielgus, Piotr Bator, Maria Pawłowska, Karol Magiera, K. Rachwał, Maria Antos, Jan Ramian, Grzegorz Łyko
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摘要

心力衰竭(HF)的发病率和死亡率都很高,是一种常见的致残性疾病,尤其是在老年人群中。心力衰竭(HF)的病理生理学非常复杂,包括氧化应激、内皮功能障碍、纤维化和炎症,尽管药物治疗取得了进展,但治疗效果往往不够理想。钠-葡萄糖共转运体 2(SGLT2)抑制剂已成为治疗不同左心室射血分数(LVEF)患者心力衰竭的关键药物。最近的临床试验表明,SGLT2 抑制剂可大大降低心衰住院率、心血管死亡率和全因死亡率。本综述将介绍 SGLT2 抑制剂的作用机制,如改善心室负荷、提高心脏代谢效率、减少炎症和坏死。此外,我们还概述了四项重要的临床试验--DAPA-HF、EMPEROR-Reduced、EMPEROR-Preserved 和 DELIVER--它们在降低保留型(HFpEF)、轻微降低型(HFmrEF)或降低型(HFrEF)心衰患者的不利心血管后果方面的有效性。这些结果证明了在全套心力衰竭治疗方案中使用 SGLT2 抑制剂的必要性,突出了它们在各种临床情况下的适应性和安全性。
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SGLT2-Inhibitors - significant role in Heart Failure treatment
Heart failure (HF), which has a high morbidity and mortality rate, is nevertheless a common and crippling ailment, especially in older populations. The complicated pathophysiology of heart failure (HF), which includes oxidative stress, endothelial dysfunction, fibrosis, and inflammation, is frequently not sufficiently treated despite advances in medication. Inhibitors of the sodium-glucose co-transporter 2 (SGLT2) have become a key treatment for HF in patients with varying left ventricular ejection fractions (LVEF). SGLT2 inhibitors have been shown in recent clinical trials to considerably lower hospitalization rates for heart failure, cardiovascular mortality, and all-cause mortality. The mechanisms of SGLT2 inhibitors, such as better ventricular loading, increased heart metabolic efficiency, and decreased inflammation and necrosis, are covered in this review. Additionally, we provide an overview of four important clinical trials—DAPA-HF, EMPEROR-Reduced, EMPEROR-Preserved, and DELIVER—highlighting their effectiveness in lowering unfavourable cardiovascular outcomes for patients with heart failure who have preserved (HFpEF), slightly reduced (HFmrEF), or reduced (HFrEF). The results validate the need for SGLT2 inhibitors in all-inclusive HF treatment plans by highlighting their adaptability and safety in a range of clinical contexts.
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