改善心血管和肾脏结局的新型抗高血糖药物临床应用中国专家建议

Expert consensus on the use of new anti-hyperglycemic agents to improve cardiovascular and renal outcomes

动脉粥样硬化性心血管病(ASCVD)和(或)慢性肾脏病(CKD)不但是2型糖尿病(T2DM)常见合并疾病,也是T2DM患者致残和致死的首要原因。近年来一系列临床研究证据表明,新型抗高血糖药物胰高糖素样肽-1受体激动剂(GLP-1 RA)和钠-葡萄糖共转运蛋白2抑制剂(SGLT2i)类药物能显著改善心血管和肾脏结局的临床获益,且安全性良好。为促使T2DM的治疗模式从单纯控制血糖转移到改善心血管和肾脏临床结局,中国心血管病学、内分泌学、肾脏病学和神经病学专家组成的专家组梳理了GLP-1 RA或SGLT2i的心血管保护的临床证据、可能机制和常见不良反应,提出了对这两类药物在临床实践中的合理定位、应用建议和注意事项,鼓励临床医师在临床实践中对T2DM患者及早启动并长期维持能够改善心血管和肾脏结局的新型抗高血糖药物治疗。

Atherosclerosis cardiovascular disease(ASCVD) and chronic kidney disease(CKD) are common co-morbidities in patients with type 2 diabetes mellitus(T2 DM), and associated with higher morbidity and disability. Newly clinical trials showed that certain sodium-glucose cotransporter 2 inhibitors(SGLT2 i) and glucagon-like peptide 1 receptor agonists(GLP-1 RA) could significantly reduce the risk of major adverse cardiovascular events(MACE) in T2 DM patients and had high safety profiles. These new exciting results triggered a major paradigm shift beyond glucose control to a broader strategy of comprehensive cardiovascular and renal risk reduction. The experts group including cardiology, and endocrinology, nephrology and neurology summarized the key beneficial clinical results of the these clinical trials and the potential mechanisms of SGLT2 i and GLP-1 RA, and developed a joint consensus with recommendations to encourage the early initiation and continuous use of the anti-hyperglycemic drugs including SGLT2 i and GLP-1 RA to achieve the improvement of cardiovascular and renal outcomes in patients with T2 DM in the real world routine practice.