磺脲类药物用于2型糖尿病患者的心血管安全性评价

Evaluation on Cardiovascular Safety of Sulfonylureas for Type 2 Diabetes Treatment

磺脲类(sulfonylureas,SUs)药物治疗2型糖尿病已有逾50年历史。自1970年University Group Diabetes Program试验发表以来,有关S U s的心血管安全性一直备受争议。尽管存在一些S U s致心血管不良反应的假说,但无一可提供可靠的证据。目前,某些观察性研究提示,SUs与心血管事件发生风险增加有关,但随机对照试验却得出了相悖结论。在评价SUs心血管安全性时,需根据具体药物、使用剂量和疗程、患者的年龄、体质指数等因素综合考虑。迄今,尚缺乏旨在探索SUs心血管结局的头对头研究数据,但正在进行的大型临床试验有望阐明SUs和心血管疾病的发生是否存在因果关系。

Sulfonylureas have been used for type 2 diabetes treatment over 50 years. Since publication of the University Group Diabetes Program in 1970, the cardiovascular safety of sulfonylureas has been contentious. Although several hypotheses linking sulfonylurea to detrimental cardiovascular events exist, none provide conclusive evidence. Presently, several observational studies suggest that sulfonylureas are associated with increased adverse cardiovascular outcome; however, randomized controlled trials have demonstrated a neutral effect. Evaluating cardiovascular safety of sulfonylureas should be based on comprehensive consideration, such as differential drugs, doses, durations, age of patient, body mass index. To date, there is lack of head-to-head study, which is focused on cardiovascular outcome of sulfonylureas. Fortunately, the current ongoing large clinical trials may clarify the cardiovascular safety of sulfonylureas.