Effects of dapagliflozin in heart failure with reduced ejection fraction and chronic obstructive pulmonary disease: an analysis of DAPA-HF.
Effects of dapagliflozin in heart failure with reduced ejection fraction and chronic obstructive pulmonary disease: an analysis of DAPA-HF.
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DOI：
10.1002/ejhf.2083
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发表时间：
2021-04
影响因子：
18.2
通讯作者：
McMurray JJV
中科院分区：
文献类型：
--
作者：
Dewan P;Docherty KF;Bengtsson O;de Boer RA;Desai AS;Drozdz J;Hawkins NM;Inzucchi SE;Kitakaze M;Køber L;Kosiborod MN;Langkilde AM;Lindholm D;Martinez FA;Merkely B;Petrie MC;Ponikowski P;Sabatine MS;Schou M;Sjöstrand M;Solomon SD;Verma S;Jhund PS;McMurray JJV
慢性阻塞性肺疾病 (COPD) 是射血分数降低 (HFrEF) 心力衰竭 (HF) 的一种重要合并症，由于 β 受体阻滞剂处方不足，导致较差的结果和往往达不到最佳治疗效果。因此，额外的有效疗法对于慢性阻塞性肺病患者尤其重要。本研究的目的是在达格列净和心力衰竭不良结果预防 (DAPA-HF) 试验的事后分析中检查与 COPD 相关的结果。我们检查了达格列净在 DAPA-HF 中的作用是否会因 COPD 状态而改变。主要结局是心衰恶化或心血管死亡的复合事件。总体而言，随机分组的 4744 名患者中有 585 名 (12.3%) 有慢性阻塞性肺病病史。患有慢性阻塞性肺病的患者更有可能是有吸烟史、肾功能较差和基线 N 末端 B 型利尿肽原较高的老年男性，并且不太可能接受 β 受体阻滞剂或盐皮质激素受体拮抗剂治疗。患有 COPD 的患者的主要结局发生率高于未患有 COPD 的患者 [每 100 人年 18.9（95% 置信区间 16.0-22.2）vs. 13.0（12.1-14.0）； COPD 与非 COPD 的风险比 (HR) 1.44 (1.21–1.72)； P < 0.001]。与安慰剂相比，达格列净对主要结局的影响在患有 [HR 0.67（95% 置信区间 0.48–0.93）] 和无 COPD 患者 [0.76（0.65–0.87）] 的患者中是一致的；交互作用 P 值 0.47]。在 DAPA-HF 中，八分之一的 HFrEF 患者伴有 COPD。患有慢性阻塞性肺病的参与者主要结局的风险较高。达格列净对所有预先指定的结局的益处在患有和不患有慢性阻塞性肺病的患者中是一致的。临床试验注册：ClinicalTrials.gov ID NCT03036124。 DAPA-HF 试验中的慢性阻塞性肺疾病 (COPD)：患者特征和临床结果。 AE，不良事件； CI，置信区间； KCCQ-TSS，堪萨斯城心肌病问卷总症状评分； MRA，盐皮质激素受体拮抗剂。
Chronic obstructive pulmonary disease (COPD) is an important comorbidity in heart failure (HF) with reduced ejection fraction (HFrEF), associated with worse outcomes and often suboptimal treatment because of under‐prescription of beta‐blockers. Consequently, additional effective therapies are especially relevant in patients with COPD. The aim of this study was to examine outcomes related to COPD in a post hoc analysis of the Dapagliflozin And Prevention of Adverse‐outcomes in Heart Failure (DAPA‐HF) trial. We examined whether the effects of dapagliflozin in DAPA‐HF were modified by COPD status. The primary outcome was the composite of an episode of worsening HF or cardiovascular death. Overall, 585 (12.3%) of the 4744 patients randomized had a history of COPD. Patients with COPD were more likely to be older men with a history of smoking, worse renal function, and higher baseline N‐terminal pro B‐type natriuretic peptide, and less likely to be treated with a beta‐blocker or mineralocorticoid receptor antagonist. The incidence of the primary outcome was higher in patients with COPD than in those without [18.9 (95% confidence interval 16.0–22.2) vs. 13.0 (12.1–14.0) per 100 person‐years; hazard ratio (HR) for COPD vs. no COPD 1.44 (1.21–1.72); P < 0.001]. The effect of dapagliflozin, compared with placebo, on the primary outcome, was consistent in patients with [HR 0.67 (95% confidence interval 0.48–0.93)] and without COPD [0.76 (0.65–0.87); interaction P‐value 0.47]. In DAPA‐HF, one in eight patients with HFrEF had concomitant COPD. Participants with COPD had a higher risk of the primary outcome. The benefit of dapagliflozin on all pre‐specified outcomes was consistent in patients with and without COPD. Clinical Trial Registration: ClinicalTrials.gov ID NCT03036124. Chronic obstructive pulmonary disease (COPD) in the DAPA‐HF trial: patient characteristics and clinical outcomes. AE, adverse event; CI, confidence interval; KCCQ‐TSS, Kansas City Cardiomyopathy Questionnaire total symptom score; MRA, mineralocorticoid receptor antagonist.
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18.2
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