Emerging therapies: The potential roles SGLT2 inhibitors, GLP1 agonists, and ARNI therapy for ARNI pulmonary hypertension.
Emerging therapies: The potential roles SGLT2 inhibitors, GLP1 agonists, and ARNI therapy for ARNI pulmonary hypertension.
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DOI：
10.1002/pul2.12028
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发表时间：
2022-01
影响因子：
2.6
通讯作者：
Brittain, Evan
中科院分区：
文献类型：
--
作者：
King, Nicholas E.;Brittain, Evan
肺动脉高压（PH）是一种高度病态的疾病。由于左心脏病（PH‐LHD）导致的PH没有特定的治疗方法，尽管有几种获批的治疗方法，但肺动脉高压（PAH）仍有相当大的剩余风险。多种实验证据将代谢功能障碍与PH‐LHD和PAH的发病机制和结局联系起来，新型代谢药物有望改善这些人群的结局。抗糖尿病钠-葡萄糖协同转运蛋白2（SGLT 2）抑制剂和胰高血糖素样肽-1（GLP 1）激动剂靶向代谢功能障碍，可改善LHD患者的结局，但尚未在PH患者中进行专门测试。血管紧张素受体/脑啡肽酶抑制剂（ARNI）可显著改善心脏血流动力学，并可能改善代谢功能障碍，从而有益于肺循环和右心室功能。基于这些药物的有前景的临床前研究和临床原理，我们探索了SGLT 2抑制剂、GLP 1激动剂和ARNI作为PH‐LHD和PAH治疗药物的潜力。
Pulmonary hypertension (PH) is a highly morbid condition. PH due to left heart disease (PH‐LHD) has no specific therapies and pulmonary arterial hypertension (PAH) has substantial residual risk despite several approved therapies. Multiple lines of experimental evidence link metabolic dysfunction to the pathogenesis and outcomes in PH‐LHD and PAH, and novel metabolic agents hold promise to improve outcomes in these populations. The antidiabetic sodium–glucose cotransporter 2 (SGLT2) inhibitors and glucagon‐like peptide‐1 (GLP1) agonists targeting metabolic dysfunction and improve outcomes in patients with LHD but have not been tested specifically in patients with PH. The angiotensin receptor/neprilysin inhibitors (ARNIs) produce significant improvements in cardiac hemodynamics and may improve metabolic dysfunction that could benefit the pulmonary circulation and right ventricle function. On the basis of promising preclinical work with these medications and clinical rationale, we explore the potential of SGLT2 inhibitors, GLP1 agonists, and ARNIs as therapies for both PH‐LHD and PAH.
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