遅ればせながら…SGLT-2阻害薬はLDL-Cを増やすけど、CVDイベントは減らす？

Effects of sodium-glucose cotransporter-2 inhibitors on cardiovascular events, death, and major safety outcomes in adults with type 2 diabetes: a systematic review and meta-analysis

Lancet Diabetes Endocrinol. 2016 May;4(5):411-9.

LANCETから、SGLT-2阻害薬のメタ解析が出ました。昨年の6月。

遅ればせながら読みました。

注目したいのは、「LDL-Cが増えるけどCVDイベントが減る」ってトコです。

Vasilakou, D, Karagiannis, T, Athanasiadou, E et al. Sodium-glucose cotransporter 2 inhibitors for type 2 diabetes: a systematic review and meta-analysis. Ann Intern Med. 2013; 159: 262–274

ディスカッションはこんな感じ。

LDL-Cは上昇。でもHDL-Cも上昇する。

L/Hが変わってないから、LDL-Cの影響は相殺されてる？

尿量増加で循環血漿量が減って、濃縮されて濃度上昇？マジか？

引用はこちらから…
Sodium-glucose cotransporter 2 inhibitors for type 2 diabetes: a systematic review and meta-analysis.
Ann Intern Med. 2013 Aug 20;159(4):262-74.

おお、この雑誌は査読パクリ捏造事件の雑誌ではありませんか…

まあそんなんはどうでもいいです。

孫引きでドンどこ進んでいくと。お互いに引用し合ってて堂々巡り、生データどこやねん！

みつけた。まんま引用です。

Changes in lipid profiles observed with SGLT2 inhibitor therapy have caused some concern.88 Dose-related increases in low-density lipoprotein cholesterol (LDL-C) were observed with canagliflozin, as shown in a pooled analysis of data from four 26-week placebo-controlled trials in which the mean percentage increases from baseline in LDL-C were 4.5% and 8.0% for 100 mg and 300 mg canagliflozin, respectively, relative to placebo.92 Canagliflozin labeling information recommends LDL-C should be monitored and treated according to standard care after initiating canagliflozin therapy.92 Statistically significant increases in high-density lipoprotein cholesterol (HDL-C) from baseline were observed with canagliflozin in four of eight placebo-controlled Phase III trials, but decreases in triglyceride levels with canagliflozin were small and were generally not statistically significant.93 For patients receiving dapagliflozin in Phase III trials, overall small mean changes in HDL-C (+2.1% to +9.3%), triglyceride (−0.9% to −10.6%), and LDL-C (−0.5% to +9.5%) were observed, but there was no clinically significant effect on lipid levels in the individual dapagliflozin studies concerned.94 For empagliflozin, a pooled analysis of four placebo-controlled Phase III trials reported small increases in HDL-C and LDL-C and small decreases in triglycerides with empagliflozin versus placebo after 24 weeks.72

容量依存的にLDL-C上昇する。ちょっとLDL-C増える。などなど…

らしいけど、逆の報告もあり。

Dapagliflozin decreases small dense low-density lipoprotein-cholesterol and increases high-density lipoprotein 2-cholesterol in patients with type 2 diabetes: comparison with sitagliptin.
Cardiovasc Diabetol 2017;16(1):8.

もうわからんわ。もうちょっと様子見です。


結論
SGLT-2阻害薬はCVDイベントは減る。LDL-CやHDL-C、TGはどうなるか薬剤種類によって違うかも。

スーパーのきのこゾーン。きのこでかいぞ。