在标准治疗基础上添加钠-葡萄糖协同转运蛋白-2(SGLT-2)抑制剂empagliflozin对2型188bet在线平台网址 心血管高危患者的心血管并发症和死亡率的影响尚未知。因此，多国学者对上述问题开展了一项研究，结果表明，与安慰剂相比，添加empagliflozin可降低2型188bet在线平台网址 心血管事件高危患者的主要复合心血管终点发生率和全因死亡率。相关文章近期在线发表于《新英格兰医学杂志》(简称NEJM)。

        研究者们将患者随机分为每日一次的10 mg或25 mg empagliflozin治疗组或安慰剂组。主要复合终点为心血管死亡、非致命性心肌梗死或非致命性卒中，分析对比汇集empagliflozin组和安慰剂组。次要复合终点为不稳定性心绞痛附加住院的主要转归。

        结果显示，共有7020例患者接受治疗，中位观察时间为3.1年。汇集empagliflozin组(4687例)和安慰剂组(2333例)分别有490例(10.5%)和282例(12.1%)受试者发生了主要终点，前者危险比(HR)为0.86。心肌梗死或卒中发生率的组间差异不显著，但empagliflozin组心血管死亡率(3.7% vs. 5.9%，相对风险减少38%)、心力衰竭住院(2.7% vs. 4.1%，相对风险减少35%)和全因死亡(5.7% vs. 8.3%，相对风险减少32%)均显著较低。在关键次要终点方面，两组差异不显著。接受empagliflozin治疗的患者生殖器感染发生率增加，其余不良事件发生率无增加。

        参考文献：Bernard Zinman,et al. September 17, 2015DOI: 10.1056/NEJMoa1504720

        Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes

        Bernard Zinman, M.D., Christoph Wanner, M.D., John M. Lachin, Sc.D., David Fitchett, M.D., Erich Bluhmki, Ph.D., Stefan Hantel, Ph.D., Michaela Mattheus, Dipl. Biomath., Theresa Devins, Dr.P.H., Odd Erik Johansen, M.D., Ph.D., Hans J. Woerle, M.D., Uli C. Broedl, M.D., and Silvio E. Inzucchi, M.D. for the EMPA-REG OUTCOME Investigators

        September 17, 2015DOI: 10.1056/NEJMoa1504720

        BACKGROUND

        The effects of empagliflozin, an inhibitor of sodium–glucose cotransporter 2, in addition to standard care, on cardiovascular morbidity and mortality in patients with type 2 diabetes at high cardiovascular risk are not known.

        METHODS

        We randomly assigned patients to receive 10 mg or 25 mg of empagliflozin or placebo once daily. The primary composite outcome was death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke, as analyzed in the pooled empagliflozin group versus the placebo group. The key secondary composite outcome was the primary outcome plus hospitalization for unstable angina.

        RESULTS

        A total of 7020 patients were treated (median observation time, 3.1 years). The primary outcome occurred in 490 of 4687 patients (10.5%) in the pooled empagliflozin group and in 282 of 2333 patients (12.1%) in the placebo group (hazard ratio in the empagliflozin group, 0.86; 95.02% confidence interval, 0.74 to 0.99; P=0.04 for superiority). There were no significant between-group differences in the rates of myocardial infarction or stroke, but in the empagliflozin group there were significantly lower rates of death from cardiovascular causes (3.7%, vs. 5.9% in the placebo group; 38% relative risk reduction), hospitalization for heart failure (2.7% and 4.1%, respectively; 35% relative risk reduction), and death from any cause (5.7% and 8.3%, respectively; 32% relative risk reduction). There was no significant between-group difference in the key secondary outcome (P=0.08 for superiority). Among patients receiving empagliflozin, there was an increased rate of genital infection but no increase in other adverse events.

        CONCLUSIONS

        Patients with type 2 diabetes at high risk for cardiovascular events who received empagliflozin, as compared with placebo, had a lower rate of the primary composite cardiovascular outcome and of death from any cause when the study drug was added to standard care. (Funded by Boehringer Ingelheim and Eli Lilly; EMPA-REG OUTCOME ClinicalTrials.gov number, NCT01131676.)