PDF(Pubmed)
Abstract：
Heart failure and cognitive impairment emerge as public health problems that need to be addressed due to the aging global population. The conditions that often coexist are strongly related to advancing age and multimorbidity. Epidemiological evidence indicates that cardiovascular disease and neurodegenerative processes shares similar aspects, in term of prevalence, age distribution, and mortality. Type 2 diabetes increasingly represents a risk factor associated not only to cardiometabolic pathologies but also to neurological conditions. The pathophysiological features of type 2 diabetes and its metabolic complications (hyperglycemia, hyperinsulinemia, and insulin resistance) play a crucial role in the development and progression of both heart failure and cognitive dysfunction. This connection has opened to a potential new strategy, in which new classes of anti-diabetic medications, such as glucagon-like peptide-1 receptor (GLP-1R) agonists and sodium-glucose cotransporter 2 (SGLT2) inhibitors, are able to reduce the overall risk of cardiovascular events and neuronal damage, showing additional protective effects beyond glycemic control. The pleiotropic effects of GLP-1R agonists and SGLT2 inhibitors have been extensively investigated. They exert direct and indirect cardioprotective and neuroprotective actions, by reducing inflammation, oxidative stress, ions overload, and restoring insulin signaling. Nonetheless, the specificity of pathways and their contribution has not been fully elucidated, and this underlines the urgency for more comprehensive research.
摘要：
由于全球人口老龄化，心力衰竭和认知障碍成为需要解决的公共卫生问题。经常共存的条件与年龄增长和多发病密切相关。流行病学证据表明，心血管疾病和神经退行性过程具有相似的方面，就患病率而言，年龄分布，和死亡率。2型糖尿病越来越多地代表不仅与心脏代谢病理学而且与神经系统疾病相关的危险因素。2型糖尿病及其代谢并发症的病理生理特征（高血糖，高胰岛素血症,和胰岛素抵抗）在心力衰竭和认知功能障碍的发展和进展中起着至关重要的作用。这种联系开启了一种潜在的新战略，其中新型抗糖尿病药物，如胰高血糖素样肽-1受体（GLP-1R）激动剂和钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂，能够降低心血管事件和神经元损伤的总体风险，显示血糖控制以外的其他保护作用。已经广泛研究了GLP-1R激动剂和SGLT2抑制剂的多效性。它们发挥直接和间接的心脏保护和神经保护作用，通过减少炎症，氧化应激，离子过载，并恢复胰岛素信号。尽管如此，通路的特异性及其贡献尚未完全阐明，这凸显了更全面研究的紧迫性。
