Sodium-Glucose Cotransporter-2 Inhibitors in Heart Failure: Racial Differences and a Potential for Reducing Disparities.
Sodium-Glucose Cotransporter-2 Inhibitors in Heart Failure: Racial Differences and a Potential for Reducing Disparities.
复制标题
DOI：
10.1161/circulationaha.120.052821
复制
发表时间：
2021-06-15
期刊：
影响因子：
37.8
通讯作者：
Butler J
中科院分区：
文献类型：
--
作者：
Morris AA;Testani JM;Butler J
最近的两项钠-葡萄糖协同转运蛋白2（SGLT 2）抑制剂（达格列净和恩格列净）临床试验现已证明，HF患者的心力衰竭（HF）住院或心血管死亡风险降低，射血分数降低，与合并糖尿病的存在无关。1尽管预先设定的亚组分析检查了SGLT 2抑制剂在HF和射血分数降低患者中的疗效，显示出各亚组（不考虑人种-种族）的一致获益，但似乎有信号表明，与其他组相比，随机分配至治疗组的黑人和亚洲患者的效应可能更大（图[A]）。黑人患者仅占入组患者的4%-7%，能够在黑人患者中显示这种程度的获益是令人信服的，鉴于HF和射血分数降低的黑人患者在风险、患病率和临床结局方面的巨大差异，值得进一步研究。主要终点的相对风险降低50%以上，这表明黑人患者的效应量非常显著，不太可能归因于偶然性，不应忽视。为了了解SGLT 2抑制的潜在获益，值得注意的是种族差异和差异之间的区别，这两者都导致了黑人患者HF的独特流行病学。根据医学研究所的说法，健康差异是由医疗保健系统的运作、法律的和监管环境以及歧视性偏见、刻板印象和不确定性造成的差异。2相反，种族差异被定义为与疾病相关的临床、生物学、遗传或表观遗传因素
Two recent clinical trials with sodium-glucose cotransporter-2 (SGLT2) inhibitors, dapagliflozin and empagliflozin, have now demonstrated a reduction in heart failure (HF) hospitalization or cardiovascular mortality risk in patients with HF and reduced ejection fraction, independent of the presence of comorbid diabetes. 1 Although the prespecified subgroup analyses examining the efficacy of SGLT2 inhibitors in patients with HF and reduced ejection fraction show a consistent benefit across subgroups irrespective of race-ethnicity, there appears to be a signal of a potentially greater effect in Black and Asian patients randomly assigned to treatment compared with other groups (Figure [A]). The ability to show this degree of benefit in Black patients, who only made up 4% to 7% of the patients enrolled, is compelling and merits further investigation given the overwhelming disparities in risk, prevalence, and clinical outcomes for Black patients with HF and reduced ejection fraction. The≈ 50% relative risk reduction in the primary end point demonstrates an effect size in Black patients that is striking, unlikely to be attributable to chance, and should not be ignored.To understand the potential benefits of SGLT2 inhibition, it is worth noting the distinction between racial differences and disparities, both of which contribute to the unique epidemiology of HF in Black patients. According to the Institute of Medicine, health disparities are differences that result from the operation of health care systems, legal and regulatory climates, and discriminatory biases, stereotyping, and uncertainty, as well. 2 Conversely, racial differences are defined as clinical, biological, genetic, or epigenetic factors associated with disease