Long-term changes in cardiovascular risk markers during administration of exenatide twice daily or glimepiride: results from the European exenatide study.
Long-term changes in cardiovascular risk markers during administration of exenatide twice daily or glimepiride: results from the European exenatide study.
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DOI：
10.1186/s12933-015-0279-z
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发表时间：
2015-09-04
影响因子：
9.3
通讯作者：
Kiljański J
中科院分区：
文献类型：
--
作者：
Simó R;Guerci B;Schernthaner G;Gallwitz B;Rosas-Guzmàn J;Dotta F;Festa A;Zhou M;Kiljański J
糖尿病患者心血管发病和死亡的风险显着增加；因此，确定降糖治疗是否会随着时间的推移影响这种风险非常重要。欧洲 EXenAtide (EUREXA) 研究中，检查了每日两次艾塞那肽（一种胰高血糖素样肽 1 受体激动剂）或二甲双胍中添加格列美脲（一种磺酰脲类药物）治疗的 2 型糖尿病患者的心血管风险标志物的变化。二甲双胍治疗失败的 2 型糖尿病患者被随机分配至每天两次加用艾塞那肽 (n = 515) 或格列美脲 (n = 514)，直至根据血红蛋白 A1C 定义治疗失败。随着时间的推移，对拟人化测量、血压（BP）、心率、血脂和高敏C反应蛋白（hsCRP）进行了评估。 36 个月内，每日两次艾塞那肽与体重 (−3.9 kg)、腰围 (−3.6 cm)、收缩压/舒张压 (−2.5/−2.6 mmHg)、高密度脂蛋白 (HDL) 胆固醇 (0.05 mmol/L)、甘油三酯 (−0.2 mmol/L) 和 hsCRP 的改善相关（−1.7 毫克/升）。心率没有增加（-0.3次/分钟），低密度脂蛋白胆固醇（0.2 mmol/L）和总胆固醇（0.1 mmol/L）略有增加。体重 (P < 0.0001)、腰围 (P < 0.001)、收缩压 (P < 0.001)、舒张压 (P = 0.023)、HDL 胆固醇 (P = 0.001) 和 hsCRP (P = 0.004) 方面，组间差异显着有利于艾塞那肽。与格列美脲相比，每天两次随机接受艾塞那肽治疗的患者需要添加至少一种抗高血压药物（20.4 vs 26.4%；P = 0.026）或降脂药物（8.4 vs 12.8%；P = 0.025）的患者较少。与格列美脲相比，每日两次添加艾塞那肽可显着、持续改善 2 型糖尿病患者的多种心血管风险标志物。临床试验注册：NCT00359762，http://www.ClinicalTrials.gov
The risk of cardiovascular morbidity and mortality is significantly increased in patients with diabetes; thus, it is important to determine whether glucose-lowering therapy affects this risk over time. Changes in cardiovascular risk markers were examined in patients with type 2 diabetes treated with exenatide twice daily (a glucagon-like peptide-1 receptor agonist) or glimepiride (a sulfonylurea) added to metformin in the EURopean EXenAtide (EUREXA) study. Patients with type 2 diabetes failing metformin were randomized to add-on exenatide twice daily (n = 515) or glimepiride (n = 514) until treatment failure defined by hemoglobin A1C. Anthropomorphic measures, blood pressure (BP), heart rate, lipids, and high-sensitivity C-reactive protein (hsCRP) over time were evaluated. Over 36 months, twice-daily exenatide was associated with improved body weight (−3.9 kg), waist circumference (−3.6 cm), systolic/diastolic BP (−2.5/−2.6 mmHg), high-density lipoprotein (HDL)-cholesterol (0.05 mmol/L), triglycerides (−0.2 mmol/L), and hsCRP (−1.7 mg/L). Heart rate did not increase (−0.3 beats/minute), and low-density lipoprotein-cholesterol (0.2 mmol/L) and total cholesterol (0.1 mmol/L) increased slightly. Between-group differences were significantly in favor of exenatide for body weight (P < 0.0001), waist circumference (P < 0.001), systolic BP (P < 0.001), diastolic BP (P = 0.023), HDL-cholesterol (P = 0.001), and hsCRP (P = 0.004). Fewer patients randomized to exenatide twice daily versus glimepiride required the addition of at least one antihypertensive (20.4 vs 26.4 %; P = 0.026) or lipid-lowering medication (8.4 vs 12.8 %; P = 0.025). Add-on exenatide twice daily was associated with significant, sustained improvement in several cardiovascular risk markers in patients with type 2 diabetes versus glimepiride. Clinical trial registration: NCT00359762, http://www.ClinicalTrials.gov