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A diabetes drug that changed the treatment guidelines for heart disease! What is this medicine?
A diabetes drug that changed the treatment guidelines for heart disease! Medical scientists have never stopped exploring the steps of treating heart failure, and new drugs are constantly emerging, bringing good news to patients with heart failure, diabetes, coronary heart disease, and kidney disease.
There is a condition in heart disease called heart failure. Heart failure has always been compared to cancer in heart disease, because once heart failure occurs, the 5-year mortality rate is as high as 50%, which is the same as the mortality rate of many cancers. So heart failure has also been compared to cancer in heart disease.
In recent decades, the treatment of heart failure has not progressed very much. The treatment of heart failure basically still stays at: ACEI/ARB+β-receptor blocker+aldosterone antagonist.
ACEI is a pristine antihypertensive drug, ARB is a sartan antihypertensive drug, β-receptor blocker is a lohr antihypertensive drug, and an aldosterone antagonist is spironolactone.
Although new drugs such as ARNI appeared a few years ago, ARNI is still a new drug developed on the basis of sartan. ARNI is sacubitril and valsartan.
The latest blockbuster news, studies have confirmed that “gliflozin” class of hypoglycemic drugs can improve the prognosis of patients with heart failure, has been written into the latest guidelines for the treatment of heart failure.
1. “European Heart Failure Diagnosis and Treatment Guidelines 2021”:
On June 29, 2021, the European Society of Cardiology-Heart Failure (ESC-HF) Annual Meeting released the “European Heart Failure Diagnosis and Treatment Guidelines 2021” online in Florence, Italy.
For patients with heart failure with low ejection fraction, the treatment path should be simplified, and the four pillars of medication should be used as soon as possible:
- ACEI/ARNI (Pristine or sacubitril and valsartan),
- BB (β-receptor blocker),
- MRA (aldosterone antagonist)
- SGLT2 inhibitor (“gliflozin” class of hypoglycemic drugs).
This is the biggest change in the latest heart failure treatment guidelines. The previous heart failure drug treatment is based on the Golden Triangle, which is Pristine/sartan/sacubatril valsartan + lohrs + spironolactone.
The latest guide adds a new drug: SGLT2 inhibitors, which are “gliflozin” drugs.
That is to say, heart failure medication has changed from the “Golden Triangle” to the “Four Pillars.”
2. What kind of medicine is “gliflozin” drug?
SGLT2 inhibitor, the full name sodium-glucose cotransporter-2 inhibitor, is a new type of oral hypoglycemic drugs, including dapagliflozin, enpagliflozin and canagliflozin.
In the 2017 edition of the “Guidelines for the Prevention and Treatment of Type 2 Diabetes in China”, SGLT2 inhibitors have been included in hypoglycemic drugs. However, SGLT2 inhibitors are not only antidiabetic drugs. Studies have found that SGLT2 inhibitors are beneficial to control proteinuria in patients with kidney disease, that is, regardless of whether they have diabetes or not, as long as they have proteinuria in this type of kidney disease, after using SGLT2 inhibitors, they can Improve the prognosis of patients with nephropathy and delay the deterioration of patients with nephropathy.
3. “gliflozin” drug and heart
Studies have confirmed that on the basis of the standard treatment of heart failure, that is, on the basis of the “Golden Triangle” treatment, “gliflozin” drug can significantly reduce patients’ cardiovascular deaths or hospitalizations or emergency visits due to heart failure by 26%. Studies have found that even if there is no diabetes, but patients with heart failure, the effect of using “gliflozin” drugs is the same.
It was also found that dapagliflozin can significantly reduce the risk of all-cause death in patients with heart failure by up to 17%. Even in patients with heart failure without diabetes, Liekin can also reduce the risk of death from these heart failures.
Based on the benefits of “gliflozin” drugs to patients with heart failure, the guidelines have changed the “Golden Triangle” into the “four pillars”, and “gliflozin” drugs are not optional in the treatment of patients with heart failure. The guidelines recommend Among the grades, it is already the highest grade IA, which means that for patients with heart failure, as long as there is no contraindication to the use of “gliflozin”, “gliflozin” should be used for the first time.
4. which patients need to use “gliflozin” drugs
The following four groups of people should use “gliflozin” drugs under the guidance of a doctor:
1. Regardless of whether there is diabetes or not, as long as the heart failure patients with low ejection fraction, that is, the patients with reduced EF value after the cardiac color Doppler ultrasound;
2. Patients with coronary heart disease and type 2 diabetes, that is, they have diabetes and coronary heart disease;
3. Type 2 diabetes patients over 50 years old with other cardiovascular risk factors, that is, type 2 diabetes patients over 50 years old, if they also have hypertension or hyperlipidemia or plaque, or obesity or smoking or have a family history And so on risk factors; 4. Regardless of whether there is diabetes, proteinuria nephropathy patients, that is, regardless of whether there is diabetes, as long as chronic kidney disease has proteinuria.
In these four types of patients, the use of “gliflozin” drugs can improve the symptoms of patients, improve the quality of life of patients, reduce the risk of heart failure hospitalization and death, or delay the deterioration of kidney disease.
5. the treatment of heart failure is a long way to go, and there is a long way to go
The treatment of heart failure is still a difficult problem in the medical profession today. Even if there are three-chamber pacemakers, heart transplants, and artificial hearts, these are all suitable for the end-stage heart failure, and there is no way; furthermore, it is expensive and risky. high.
For the vast majority of patients with heart failure, the best treatment currently is medication.
In the 1940s, the treatment of heart failure was based on cardiotonic diuretics, namely digitalis drugs and diuretic drugs. Of course, this treatment is still suitable for the rescue process of acute heart failure. But it has no effect on the mortality of chronic heart failure, so it is not the basis for heart failure treatment. However, diuretic drugs are still the first choice for patients with obvious symptoms of heart failure and patients with excessive body water and swelling.
In the 1970s, blood vessel dilation and inotropic drugs were commonly used such as nitroglycerin, cedilan, milrinone, and amrinone.
In the 1990s, we entered the era of neurohormonal suppression, which is the “Golden Triangle” we mentioned above. ACEI is xxpril, which successfully reduced the total mortality of patients with heart failure by 27%. Betaloc, a beta-blocker, reduces the mortality of patients with heart failure by 34% to 35%. The aldosterone receptor antagonist, spironolactone, reduces the mortality of patients with heart failure by 24% to 30%.
In recent years, new members have been added to the heart failure treatment family, including new drugs such as sacubatril, valsartan, liegin, and verizil. Sacubitril and valsartan can further reduce the risk of death in patients with heart failure by 20%, and Liegin drug can significantly reduce the risk of cardiovascular death in patients by 26%.
Medical scientists have never stopped exploring the steps of treating heart failure, and new drugs are constantly emerging, bringing good news to patients with heart failure, diabetes, coronary heart disease, and kidney disease.
But even so, heart failure is still an irreversible disease. Heart failure still needs to be prevented, especially for patients with long-term hypertension, coronary heart disease, and heart disease. You must actively control blood pressure and treat your heart properly. Disease, so as to prevent heart failure, this is the best treatment.
(source:internet, reference only)