循環器ジャーナル66巻1号

2018年01月発行

特集 循環器診療　薬のギモン—エキスパートに学ぶ薬物治療のテクニック Ⅰ．心不全診療でのギモン

糖尿病を合併した慢性心不全患者にDPP-4阻害薬とSGLT2阻害薬をどのように使用していくか？

著者： 朝倉正紀¹ 西村晃一¹

所属機関： ¹兵庫医科大学循環器内科

ページ範囲：P.40 - P.46

Point
・DPP-4阻害薬は，心不全の発症リスクについては定まった見解は出ていない．
・SGLT2阻害薬は，EMPA-REG OUTCOME試験とCANVAS試験の結果から，心不全および腎機能進行のリスクを低減することが示された．

参考文献

1) Turnbull FM, Abraira C, Anderson RJ, et al:Intensive glucose control and macrovascular outcomes in type 2 diabetes. Diabetologia 52:2288-2298, 2009

2) Marso SP, Daniels GH, Brown-Frandsen K, et al;LEADER Steering Committee;LEADER Trial Investigators:Liraglutide and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med 375:311-322, 2016

3) Marso SP, Bain SC, Consoli A, et al;SUSTAIN-6 Investigators:Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes. N Engl J Med 375:1834-1844, 2016

4) Pfeffer MA, Claggett B, Diaz R, et al;ELIXA Investigators:Lixisenatide in Patients with Type 2 Diabetes and Acute Coronary Syndrome. N Engl J Med 373:2247-2257, 2015

5) Shigeta T, Aoyama M, Bando YK, et al:Dipeptidyl peptidase-4 modulates left ventricular dysfunction in chronic heart failure via angiogenesis-dependent and-independent actions. Circulation 126:1838-1851, 2012

6) Takahashi A, Asakura M, Ito S, et al:Dipeptidyl-peptidase Ⅳ inhibition improves pathophysiology of heart failure and increases survival rate in pressure-overloaded mice. Am J Physiol Heart Circ Physiol 304:H1361-1369, 2013

7) Scirica BM, Bhatt DL, Braunwald E, et al;SAVOR-TIMI 53 Steering Committee and Investigators:Saxagliptin and cardiovascular outcomes in patients with type 2 diabetes mellitus. N Engl J Med 369:1317-1326, 2013

8) White WB, Cannon CP, Heller SR, et al;EXAMINE Investigators:Alogliptin after acute coronary syndrome in patients with type 2 diabetes. N Engl J Med 369:1327-1335, 2013

9) Zannad F, Cannon CP, Cushman WC, et al;EXAMINE Investigators:Heart failure and mortality outcomes in patients with type 2 diabetes taking alogliptin versus placebo in EXAMINE:a multicentre, randomised, double-blind trial. Lancet 385:2067-2076, 2015

10) Green JB, Bethel MA, Armstrong PW, et al;TECOS Study Group:Effect of Sitagliptin on Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med 373:232-242, 2015

11) Zinman B, Wanner C, Lachin JM, et al;EMPA-REG OUTCOME Investigators:Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. N Engl J Med 373:2117-2128, 2015

12) Neal B, Perkovic V, Mahaffey KW, et al;CANVAS Program Collaborative Group:Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes. N Engl J Med 377:644-657, 2017

13) Persson F, Nyström T, Jørgensen ME, et al:Dapagliflozin Compared to DPP-4 inhibitors is Associated with Lower Risk of Cardiovascular Events and All-cause Mortality in Type 2 Diabetes Patients（CVD-REAL Nordic）:a multinational observational study. Diabetes Obes Metab. 2017 Aug 3. doi:10.1111/dom.13077.［Epub ahead of print］