PTE KK, II. Belgyógyászati Klinika és Nephrologiai Centrum
Az antidiabeticumok és a cardiovascularis kockázat
Molnár Gergő Attila dr., Laczy Boglárka dr., Sélley Eszter dr., Kun Szilárd dr., Wittmann István dr.
Összefoglalás
Az antidiabetikus kezelés megválasztásánál a glykaemiás hatékonyság mellett kiemelt jelentősége kell hogy legyen a hasz- nált antidiabeticum cardiovascularis biztonságosságának is. A roziglitazonnal kapcsolatos adatok alapján a gyógyszerek engedélyeztetését ma már a hatóságok (pl. FDA) a bevezetést megelőző klinikai vizsgálatok cardiovascularis biztonságos- sági adatait figyelembe véve végzik el. A rendelkezésre álló adatok a metformin cardiovascularis védő hatása mellett szól- nak. A szulfanilureák cardiovascularis szempontból általában nem előnyösek, ez alól a gliclazid jelent kivételt. A glinidek vonatkozásában az adatok sem fokozott kockázat, sem védőhatás mellett nem szólnak. Az akarbóz több vizsgálat adatai alapján szignifikáns cardiovascularis védőhatású. Az inkretinrendszerre ható szerek vonatkozásában még hiányoznak az igazán hosszú távú biztonságossági adatok, azonban a patofiziológiai hatások és az eddigi, rövidebb távú adatok car- diovascularis szempontból legalábbis semleges jelleget sugallnak. Az előbbi csoporthoz hasonlóan a gliflozinok esetében is még váratnak magukra a hosszú távú biztonságossági eredmények.
■ Kulcsszavak: antidiabeticum, cardiovascularis kockázat, mortalitás, myocardialis infarctus, stroke
Antidiabetic medication and cardiovascular risk
Summary: Besides the glycemic efficacy, also the cardiovascular safety has to be considered as an important issue, when an atidiabetic medication has to be chosen. Upon data concerning rosiglitazon, the registration of novel antidiabetics is performed by the authorities (e.g. FDA) taking into consideration of the safety data from pre-marketing clinical studies.
Currently available data support a cardiovascular protective role of metformin. The sulphonylureas are not beneficial from cardiovascular point of view, with gliclazide being an exception. Data concerning glinides do not support either an increased risk or a protective effect. Acarbose has a significant cardiovascular protective role according to some studies.
Real long-term safety data are still lacking for agents acting on the incretin system (GLP-1 receptor analogues and DPP-4 inhibitors), but pathophysiological effect and short-term data suggest an at least neutral cardiovascular effect. Just as for the latter group, long-term safety data are awaited also for the gliflozins.
■ Key words: antidiabetic medication, cardiovascular risk, mortality, myocardial infarct, stroke DIABETOLOGIA HUNGARICA 22 (№1) 103–110. 2014. március
Rövidítések
CV: cardiovascularis; HbA1c: hemoglobin A1c; ACE: angiotenzin-konvertáló enzim; BNP: agyi natriuretikus peptid; CA- ROLINA: Cardiovascular Outcome Study of Linagliptin Versus Glimepiride in Patients With Type 2 Diabetes; DPP-4:
dipeptidil-peptidáz; EBM: evidenciaalapú orvoslás; ELIXA: Evaluation of Cardiovascular Outcomes in Patients With Type 2 Diabetes After Acute Coronary Syndrome During Treatment With AVE0010 (Lixisenatide); EMA: European Me- dicines Agency; EXAMINE: Examination of Cardiovascular Outcomes with Alogliptin vs. Standard of Care; EXSCEL:
Exenatide Study of Cardiovascular Event Lowering Trial; FDA: U.S. Food and Drug Administration; GLP-1: glukagon-
litAzone Clinical Trial In macroVascular Events; SAVOR-TIMI: Saxagliptin Assessment of Vascular Outcomes Recorded in Patients with Diabetes Mellitus – Thrombolysis in Myocardial Infarction; SGLT-2: nátrium-glukóz transzporter-2;
STOP-NIDDM: Study to Prevent NIDDM; TECOS: Trial to Evaluate Cardiovascular Outcomes after Treatment with Si- tagliptin; UKPDS: United Kingdom Prospective Diabetes Study
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Irodalom
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1. táblázat. Az antidiabeticum-csoportok és a cardio- vascularis kockázat összefüggése
Metformin Csökkenti a CV kockázatot Alfa-glukozidáz-inhibitor Csökkenti a CV kockázatot Prandialis glukózregulátor Nem rontja a CV kockázatot
Inzulin Nincs adat, hogy javítaná a CV kockázatot Szulfanilureák Gliclazid kivételével rontják a
CV kockázatot Inkretin-terápiák Az eddigi „EBM” adatok szerint
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Közlésre érkezett: 2013. december 9.
Közlésre elfogadva: 2014. január 24.
A levelezésért felelős szerző:
Prof. Dr. Wittmann István 7624 Pécs, Pacsirta u. 1.
E-mail: istvan.wittmann@aok.pte.hu
