PDF(Pubmed)
Abstract：
Therapy with glucagon-like peptide 1 (GLP1) receptor agonists has raised great interest for its beneficial cardiovascular effects in preventing atherosclerosis and heart failure-related outcomes. However, while evidence about atherosclerosis consistently suggests a cardioprotective potential with class effect, controversies remain on its impact on heart failure. GLP1 receptor agonists appear to prevent hospitalization for new-onset heart failure and reduce symptoms in heart failure with preserved ejection fraction (as demonstrated by the recent STEP-HFpEF Trial). Still, GLP1 agonism has resulted in neutral or even harmful effects in patients with established heart failure with reduced ejection fraction (the LIVE trial). GLP1 receptor agonists benefit the cardiovascular system indirectly through their marked metabolic effects (improved weight management, glycemic control, blood pressure, systemic and tissue inflammation), while direct effects on the heart have been questioned. Nonetheless, weight loss alone achieved through GLP1 receptor agonists has failed in improving left ventricular functions. Tirzepatide is a dual agonist of GLP1 and glucose-dependent insulinotropic polypeptide, representing an innovative treatment option in diabetes with a major impact on weight loss and promising cardiovascular benefits. Whether this class of therapies is going to change the history of heart failure is an ongoing debate.
摘要：
胰高血糖素样肽1（GLP1）受体激动剂的治疗对预防动脉粥样硬化和心力衰竭相关结果的有益心血管作用引起了极大的兴趣。然而,虽然关于动脉粥样硬化的证据始终表明具有类效应的心脏保护潜力，其对心力衰竭的影响仍存在争议。GLP1受体激动剂似乎可以预防新发心力衰竭的住院，并减轻射血分数保留的心力衰竭症状（如最近的STEP-HFpEF试验所示）。尽管如此，GLP1激动作用已导致具有降低的射血分数的既定心力衰竭患者的中性甚至有害影响（LIVE试验）。GLP1受体激动剂通过其显著的代谢作用(改善体重管理,血糖控制,血压,全身和组织炎症)，虽然对心脏的直接影响受到质疑。尽管如此，仅通过GLP1受体激动剂实现的体重减轻未能改善左心室功能。Tirzepatide是GLP1和葡萄糖依赖性促胰岛素多肽的双重激动剂，代表糖尿病的创新治疗选择，对减肥和有希望的心血管益处有重大影响。这类疗法是否会改变心力衰竭的历史是一个持续的争论。
