Inhibitory SGLT-2 — leki hipoglikemizujące, kardioprotekcyjne i nefroprotekcyjne
Streszczenie
Cukrzyca jest istotnym czynnikiem ryzyka rozwoju niewydolności serca i najczęstszą przyczyną
schyłkowej niewydolności nerek. Inhibitory ko-transportera sodowo-glukozowego-2 (SGLT-2)
są nowymi lekami przeciwcukrzycowymi, których oddziaływanie wykracza daleko poza
prostą kontrolę glikemii. Inhibitory SGLT-2 zapobiegają pogarszaniu się niewydolności
serca zarówno u pacjentów z, jak i bez cukrzycy. Leki zmniejszają także ryzyko poważnych
zdarzeń sercowo-naczyniowych i zgonów z powodu chorób układu krążen ia, u pacjentów
z wysokim ryzykiem sercowo-naczyniowym. Korzystne efekty wydają się związane
z lepszą kontrolą glikemii, zwiększoną diurezą i natriurezą oraz zmniejszeniem objętości
płynu pozakomórkowego. Bezpośrednie oddziaływanie na mięsień sercowy jest wynikiem
znacznej redukcji poziomu sodu i wapnia w kardiomiocytach, hamowania włóknienia oraz
nasilenia erytropoezy i ketogenezy. Inhibitory SGLT-2 redukują albuminurię, spowalniają
włóknienie nerek i zachowują ich wydolność. Zastosowanie leków powinno być brane
pod uwagę u wszystkich pacjentów z cukrzycową chorobą nerek, niezależnie od stopnia
kontroli glikemii.
Inhibitory SGLT-2 są rekomendowane jako leki pierwszego rzutu w długotrwałej terapii
chorych na cukrzycę typu 2 z niewydolnością serca, z wysokim ryzykiem miażdżycy i jej
powikłań oraz z cukrzycową chorobą nerek.
Słowa kluczowe: cukrzycainhibitory SGLT-2niewydolność sercacukrzycowa choroba nerek
Referencje
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