2型糖尿病合并动脉粥样硬化性心血管疾病患者降糖药物应用专家共识

Chinese expert consensus on anti-diabetic agents in treating patients with type 2 diabetes and atherosclerotic cardiovascular disease

动脉粥样硬化性心血管疾病(ASCVD)包括冠心病、缺血性卒中及外周动脉疾病,是2型糖尿病(T2DM)患者致死和致残的主要原因。目前国内外糖尿病防治指南均推荐,对于T2DM患者,必须加强高血糖、高血压、血脂异常、肥胖等多重心血管危险因素的综合管理,以最大限度降低心血管事件和死亡风险。近年来,由于美国FDA的强制性要求,全球已完成或正在开展一系列新型降糖药物的心血管结局研究(CVOT)。已经公布的两项CVOT显示,在伴有心血管疾病或高危因素的T2DM患者中,恩格列净和利拉鲁肽可显著降低心血管事件和死亡风险。因此,本共识建议,对于T2DM合并ASCVD患者,在选择降糖药物时,除关注降糖疗效外,还应特别注意心血管安全性问题;对于血糖控制不佳的这类患者,在二甲双胍等标准治疗的基础上可考虑优先选择具有明确心血管获益证据的降糖药物(如利拉鲁肽或恩格列净)治疗。

Atherosclerotic cardiovascular disease（ ASCVD）,defined as coronary heart disease,cerebral ischemic stroke and peripheral arterial disease presumed to be of atherosclerotic origin,is the leading cause of morbidity and mortality in patients with type 2 diabetes mellitus（ T2DM）. In the national and international guidelines for T2 DM,it has been recommended that multiple cardiovascular risk factors,including hyperglycemia,hypertension,dyslipidemia and obesity,should be controlled simultaneously to reduce the risk of cardiovascular events and mortality. In responding to the FDA regulations, many cardiovascular outcome trials（ CVOT） of novel anti-diabetic agents have been completed or are ongoing.Two recently published CVOTs show that liraglutide and empagliflozin significantly reduce the risk of major adverse cardiovascular events（ MACE） in T2 DM patients with a history of or at high risk for cardiovascular diseases. Therefore,it is recommended that cardiovascular effects should be considered when choosing antidiabetic agents in patients with T2 DM and ASCVD. The anti-diabetic agents whose cardiovascular benefits have been shown（ eg. liraglutide and empagliflozin） should be prioritized as an add-on therapy in these patients with inadequate glycemic control on standard glucose-lowering medication such as metformin.