【論文摘要】Topic 2: Old and New Anti-hyperglycemia Agents and Cardiovascular Disease(Protagonist)

10.6907/SCJ.201909/SP_1(2).0198

Daisuke Yabe

海峽循環醫學雜誌

1卷2S期（2019 / 09 / 01）

237 - 237

英文

Patients with diabetes show increased risk of cardiovascular disease and mortality, which reduces their life expectancy; the effects of anti-diabetes drugs on cardiovascular disease and mortality are therefore of great interest. The UKPDS and its follow-up study employing metformin and sulfonylureas as well as insulin reported ~15% reduction in the risk of myocardial infarction; risk of cardiovascular disease and mortality was also reduced by intensive glycemic control in the ACCORD trial, but this effect may be partly traceable to the increased possibility of severe hypoglycemia associated with the use of sulfonylureas and insulin. ＜＜?＞＞ In addition to insulin, sulfonylureas, and metformin, several anti-diabetes drugs are available today to manage type 2 diabetes (T2D). Among these, GLP-1R agonists and SGLT2 inhibitors have been gaining much attention because cardiovascular outcome trials have demonstrated that they significantly reduce cardiovascular disease and mortality risk over standard care. GLP-1R agonists not only improve glycemia by enhancing insulin secretion glucose-dependently, they reduce bodyweight and blood pressure in addition to ameliorating lipid profile, chronic inflammation, oxidative stress and endothelial dysfunction, all of which contribute to prevention of atherosclerosis and subsequent cardiovascular disease and mortality. SGLT2 inhibitors, in turn, improve glycemia and reduce bodyweight by enhancing urinary glucose excretion; they also reduce blood pressure and ameliorate cardiac muscle metabolism, preventing cardiovascular disease, especially heart failure. While cardiovascular mortality among patients with diabetes in Asia is much lower than in US or Europe, combination of GLP-1R agonists and SGLT2 inhibitors might better protect all T2D patients from cardiovascular mortality. In the current debate, I'd like to present evidence that supports a role of available anti-diabetes drugs in the prevention of cardiovascular disease and mortality in T2D from an Asian perspective.