| 당뇨병 신약의 cardiovascular outcome trials 결과의 해석 |
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고관표1,2, 진현정3 |
1제주대학교 의과대학 내과학교실
2제주대학교병원 내과
3제주의료원 내과 |
| Interpretation of cardiovascular outcome trials results of new antidiabetic agents |
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Gwanpyo Koh1,2, Hyounjung Chin3 |
1Department of Internal Medicine, Jeju National University College of Medicine, Jeju, Republic of Korea
2Department of Internal Medicine, Jeju National University Hospital, Jeju, Republic of Korea
3Department of Internal Medicine, Jeju Medical Center, Jeju, Republic of Korea |
Correspondence:
Hyounjung Chin, Tel: 82-64-720-2167, Fax: 82-64-724-2103, Email: chinhyounjung@gmail.com
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Received: 28 May 2024 • Revised: 2 July 2024 • Accepted: 4 July 2024 |
| Abstract |
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The incidence of diabetes is continuously increasing worldwide, resulting in a considerable socioeconomic burden. Glycemic control using traditional diabetes medications prevents microvascular complications; however, there is no objective evidence that it prevents macrovascular complications. In the 21st century, concerns have arisen that strict glycemic control and the diabetes drug rosiglitazone might increase mortality. This led the United States Food and Drug Administration to establish guidelines that require that cardiovascular outcome trials (CVOTs) with 3-point major adverse cardiovascular events (3-P MACE) as the primary endpoints be performed for new diabetes drugs. Since then, 20 CVOTs have been reported. Dipeptidyl peptidase 4 inhibitors do not increase the incidence of cardiovascular disease; however, saxagliptin increases the risk of heart failure. Sodium-glucose cotransporter inhibitors (SGLT2is) and glucagonlike peptide 1 receptor agonists (GLP-1RAs) not only have proven cardiovascular safety but also have shown results beyond expectations by reducing the incidence of cardiovascular diseases. Additionally, SGLT2is have been reported to markedly prevent heart failure and kidney disease. The reduction in 3-P MACE by GLP-1RAs was observed only with long-acting agents; long-acting GLP-1RAs also markedly reduced renal endpoints. However, no preventive effect against heart failure was observed with GLP-1RAs. The preventive effects of both drug types against cardiovascular and kidney diseases appear to be independent of glycemic control. In conclusion, based on CVOT results, it is necessary to actively prescribe SGLT2is and GLP-1RAs to prevent cardiovascular disease in patients with diabetes, regardless of glycemic control. |
| Key Words:
Clinical trial, Sodium-glucose transporter 2 inhibitors, Glucagon-like peptide-1 receptor agonists, Heart failure, Kidney diseases |
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