In the clinic, we found that many diabetic patients are accompanied by cardiovascular diseases such as coronary heart disease, and diabetes is also one of the high risk factors for cardiovascular disease. Disorders of blood glucose metabolism often damage the lining of blood vessels, eventually leading to the onset of coronary atherosclerosis. The purpose of diabetes treatment is to control blood sugar and reduce the occurrence of cardiovascular events. At present, evidence-based medical evidence fully shows that metformin, dapagliflozin, and liraglutide hypoglycemic drugs have the effect of improving myocardial metabolism and protecting cardiovascular disease.
Metformin
Metformin, which mainly reduces blood glucose by reducing liver sugar output, inhibiting glucose absorption in the small intestine, promoting glucose oxidative decomposition, improving insulin resistance, reducing adenylate-activated protein kinase and lowering blood sugar, has a clear role in preventing cardiovascular complications. By regulating adenylate-activated protein kinase and lipid and sugar metabolism, thereby improving the energy metabolism state of the myocardium. By increasing the bioavailability of nitric oxide, reducing interstitial fibrosis, reducing the deposition of late glycosylated end products, inhibiting cardiomyocyte apoptosis, and delaying cardiac remodeling.
The use of metformin in obese patients with type 2 diabetes reduces the risk of all-cause death and myocardial infarction, with a significantly better benefit than sulfonylureas (glyphs XX) and insulin. May be associated with lower mortality and readmission rates in patients with diabetes mellitus and heart failure. If there are no contraindications or intolerances, metformin is the first and full drug for the treatment of type 2 diabetes; the preferred drug for overweight or obese patients with type 2 diabetes; it can effectively reduce the risk of developing type 2 diabetes in prediabetes.
However, with a glomerular filtration rate (eGFR) of 30, metformin can be continued, but patients with heart failure who are unstable or decompensated and require hospitalization should be avoided.
Dapagliflozin, empagliflozin, cabreachflozin
This class of drugs is called sodium-glucose cotransporter 2 inhibitor, which can inhibit the absorption of glucose in the original urine by the renal tubules, increase the excretion of urine glucose, thereby reducing blood glucose; reducing the level of glucose in the circulation, increasing blood ketone bodies and free fatty acids; increasing the expression and activity of key enzymes in the process of ketone body and fatty acid metabolism, and reducing glucose aerobic oxidation.
Listin drugs reduce the risk of cardiovascular events in patients with diabetes and significantly reduce the main cardiovascular events in patients with type 2 diabetes who have atherosclerotic cardiovascular disease or have high risk factors for atherosclerotic cardiovascular disease. Listing of nets in patients with concomitant myocardial infarction also significantly reduces these risks.
Improving prognosis for heart failure patients with reduced ejection fraction, the addition of dapagliflozin to reduce the risk of primary endpoint events and 18% cardiovascular death in heart failure patients with reduced ejection fraction was reduced on the basis of current guidelines for heart failure treatment. The addition of empagliflozin reduces the risk of hospitalization for cardiovascular death or heart failure by 25% and the risk of hospitalization for heart failure by 30%, a protective effect independent of the presence or absence of diabetes.
These drugs are suitable for: heart failure with or without type 2 diabetes mellitus with reduced ejection fraction of cardiac function grade II. to IV., and on the basis of current guidelines recommended drug therapy, the columnolog is used to reduce the hospitalization rate of heart failure and the risk of cardiovascular death; type 2 diabetes mellitus with atherosclerotic cardiovascular disease, or atherosclerotic cardiovascular disease risk factors, the use of columnine is recommended to reduce the risk of cardiovascular events.
Liraglutide, dula glycopeptide, exenatide, smeglutide and the like
Liraglutide, dulaglutide, exenatide, smeglutide, etc., is a glucagon-like peptide-1 receptor agonist, by simulating the natural glucagon-like peptide-1 activation of glucagon-like peptide-1 receptor, in a glucose concentration-dependent manner to enhance insulin secretion, inhibit glucagon secretion, and can delay gastric emptying, through the central appetite inhibition to reduce the amount of food, so as to achieve the effect of lowering blood sugar.
The risk of hypoglycemia when used alone is small, and it has the effect of weight loss, blood pressure reduction and improvement of blood lipids. In patients with type 2 diabetes mellitus with atherosclerotic cardiovascular disease or at very high risk of cardiovascular risk, the use of these drugs on the basis of standard therapy can significantly reduce or have a decreasing trend of major cardiovascular adverse events. In patients with diabetes mellitus, liraglutide (1.80 mg/day) reduced the risk of major cardiovascular adverse events by 13%, smeglutide (0.5 to 1.0 mg/week) by 26%, and duraglutide (1.5 mg/once weekly) by 12%.
These agents may be used alone and in combination with other hypoglycemic agents other than dipeptidyl peptidase 4 inhibitors (sitagliptin, sraglitine, etc.) to treat patients with substandard glycemic control; for patients with atherosclerotic cardiovascular disease or a very high-risk cardiovascular disease risk, regardless of baseline glycosylated hemoglobin or individualized glycosylated hemoglobin target values, it is recommended to combine such drugs with evidence of cardiovascular benefit to reduce the risk of cardiovascular events.
In short, these 3 types of drugs themselves are used as hypoglycemic drugs, but they can also improve myocardial metabolism and reduce the risk of cardiovascular events, especially for patients with diabetes mellitus with coronary heart disease and heart failure, of which the net class of drugs has been used as one of the "golden horns" for the treatment of heart failure.