减肥之外:胰高血糖素样肽-1 受体激动剂治疗射血分数保留型心力衰竭的潜力

IF 4.5 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Heart Failure Reviews Pub Date : 2024-09-13 DOI:10.1007/s10741-024-10438-2
Tian-Yu Wang, Qiang Yang, Xin-Yi Cheng, Jun-Can Ding, Peng-Fei Hu
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引用次数: 0

摘要

射血分数保留型心力衰竭(HFpEF)是一种具有多种表型的异质性综合征,而肥胖是 HFpEF 最常见且与临床相关的表型之一。肥胖通过多种机制导致心衰,包括钠潴留、神经激素失调、能量底物代谢改变、内脏脂肪组织扩张和低度全身炎症。胰高血糖素样肽-1(GLP-1)是增量素家族中的一种激素。它由位于回肠远端和结肠中的称为神经内分泌 L 细胞的特化细胞产生。GLP-1 通过促进胰腺β细胞分泌葡萄糖依赖性胰岛素、抑制胰腺α细胞释放胰高血糖素以及阻断肝脏葡萄糖生成来降低血糖水平。最近的证据表明,GLP-1 受体激动剂(GLP-1 RAs)可显著改善肥胖型高频心衰患者的体力活动限制和运动能力。GLP-1 RAs 可能的心脏保护机制包括减少心外膜脂肪组织厚度、防止肾素-血管紧张素-醛固酮系统活化、改善心肌能量代谢、减少全身炎症和心脏氧化应激以及延缓动脉粥样硬化的进展。本综述探讨了肥胖对 HFpEF 潜在机制的影响,总结了 GLP-1 RAs 对 2 型糖尿病患者心血管预后的试验数据,并强调了 GLP-1 RAs 的潜在心脏保护机制,从而为肥胖 HFpEF 患者使用 GLP-1 RAs 提供了病理生理学和临床依据。
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Beyond weight loss: the potential of glucagon-like peptide-1 receptor agonists for treating heart failure with preserved ejection fraction

Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous syndrome with various phenotypes, and obesity is one of the most common and clinically relevant phenotypes of HFpEF. Obesity contributes to HFpEF through multiple mechanisms, including sodium retention, neurohormonal dysregulation, altered energy substrate metabolism, expansion of visceral adipose tissue, and low-grade systemic inflammation. Glucagon-like peptide-1 (GLP-1) is a hormone in the incretin family. It is produced by specialized cells called neuroendocrine L cells located in the distal ileum and colon. GLP-1 reduces blood glucose levels by promoting glucose-dependent insulin secretion from pancreatic β cells, suppressing glucagon release from pancreatic α cells, and blocking hepatic gluconeogenesis. Recent evidence suggests that GLP-1 receptor agonists (GLP-1 RAs) can significantly improve physical activity limitations and exercise capacity in obese patients with HFpEF. The possible cardioprotective mechanisms of GLP-1 RAs include reducing epicardial fat tissue thickness, preventing activation of the renin–angiotensin–aldosterone system, improving myocardial energy metabolism, reducing systemic inflammation and cardiac oxidative stress, and delaying the progression of atherosclerosis. This review examines the impact of obesity on the underlying mechanisms of HFpEF, summarizes the trial data on cardiovascular outcomes of GLP-1 RAs in patients with type 2 diabetes mellitus, and highlights the potential cardioprotective mechanisms of GLP-1 RAs to give a pathophysiological and clinical rationale for using GLP-1 RAs in obese HFpEF patients.

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来源期刊
Heart Failure Reviews
Heart Failure Reviews 医学-心血管系统
CiteScore
10.40
自引率
2.20%
发文量
90
审稿时长
6-12 weeks
期刊介绍: Heart Failure Reviews is an international journal which develops links between basic scientists and clinical investigators, creating a unique, interdisciplinary dialogue focused on heart failure, its pathogenesis and treatment. The journal accordingly publishes papers in both basic and clinical research fields. Topics covered include clinical and surgical approaches to therapy, basic pharmacology, biochemistry, molecular biology, pathology, and electrophysiology. The reviews are comprehensive, expanding the reader''s knowledge base and awareness of current research and new findings in this rapidly growing field of cardiovascular medicine. All reviews are thoroughly peer-reviewed before publication.
期刊最新文献
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