Heart Failure Risk Stratification and Efficacy of Sodium-Glucose Cotransporter-2 Inhibitors in Patients With Type 2 Diabetes Mellitus
Heart Failure Risk Stratification and Efficacy of Sodium-Glucose Cotransporter-2 Inhibitors in Patients With Type 2 Diabetes Mellitus
复制标题
DOI：
10.1161/circulationaha.119.042685
复制
发表时间：
2019-11-05
期刊：
影响因子：
37.8
通讯作者：
Sabatine, Marc S.
中科院分区：
文献类型：
--
作者：
Berg, David D.;Wiviott, Stephen D.;Sabatine, Marc S.
背景：2 型糖尿病 (T2DM) 患者发生心力衰竭的风险增加。钠-葡萄糖协同转运蛋白 2 抑制剂可降低 T2DM 患者因心力衰竭 (HHF) 住院的风险。我们的目的是开发和验证 T2DM 患者 HHF 的实用临床风险评分，并评估该评分是否可以识别使用钠-葡萄糖协同转运蛋白 2 抑制剂可最大程度降低 HHF 风险的 T2DM 高危患者。方法：我们为 SAVOR-TIMI 53 安慰剂组的 8212 名 T2DM 患者制定了 HHF 临床风险评分（糖尿病患者血管结果的沙格列汀评估 - 心肌梗死溶栓 53）。使用多变量 Cox 回归和独立临床风险指标评估候选变量，实现 HHF 风险 P20 倍梯度的统计显着性（趋势 P = 3 分），患者 4 年时 Kaplan-Meier 估计的 HHF 风险绝对值分别降低 1.5% 和 2.7%。结论：使用新型 HHF 临床风险评分对 T2DM 患者进行风险分层，识别出 HHF 风险较高的患者，这些患者从钠-葡萄糖协同转运蛋白 2 抑制中获得更大的绝对获益。
Background: Patients with type 2 diabetes mellitus (T2DM) are at increased risk of developing heart failure. Sodium-glucose cotransporter-2 inhibitors reduce the risk of hospitalization for heart failure (HHF) in patients with T2DM. We aimed to develop and validate a practical clinical risk score for HHF in patients with T2DM and assess whether this score can identify high-risk patients with T2DM who have the greatest reduction in risk for HHF with a sodium-glucose cotransporter-2 inhibitor. Methods: We developed a clinical risk score for HHF in 8212 patients with T2DM in the placebo arm of SAVOR-TIMI 53 (Saxagliptin Assessment of Vascular Outcomes Recorded in Patients With Diabetes Mellitus-Thrombolysis in Myocardial Infarction 53). Candidate variables were assessed using multivariable Cox regression, and independent clinical risk indicators achieving statistical significance of P20-fold gradient of HHF risk (P for trend = 3 points) patients having 1.5% and 2.7% absolute reductions in Kaplan-Meier estimates of HHF risk at 4 years, respectively. Conclusions: Risk stratification using a novel clinical risk score for HHF in patients with T2DM identifies patients at higher risk for HHF who derive greater absolute benefit from sodium-glucose cotransporter-2 inhibition.