Article, see p 323 Cardiovascular disease accounts for the majority of excess deaths seen in patients with type 2 diabetes mellitus (T2D).1 Thus, to improve outcomes in this population, clinicians should focus on therapies that decrease the risk of subsequent cardiovascular events. Over the last 2 years, randomized controlled clinical trials have identified several agents that decrease cardiovascular events in patients with T2D with or at high risk for cardiovascular disease (CVD)—effects likely unrelated to glucose lowering, the indication for which they were originally developed.2–5 One of these therapies (empagliflozin), a sodium glucose cotransporter-2 inhibitor (SGLT-2i), was found to reduce the risks of major adverse cardiovascular events (MACEs), cardiovascular death, hospitalization for heart failure, and progression of nephropathy in patients with CVD.2 However, it is unknown whether SGLT-2i can also reduce cardiovascular events in the lower risk population of patients with T2D but without established CVD. The majority of patients with T2D do not have established CVD.6 Although in general their risk of adverse cardiac events is lower than that of patients with T2D and CVD, this population remains at substantial lifetime risk of future ischemic events.7 Furthermore, cardiovascular events that may not be directly mediated by ischemia, such as heart failure, are also important and occur in patients with and without established CVD.7 In an analysis of the global REACH registry (Reduction of Atherothrombosis for Continued Health) of ≈20 000 patients with T2D, 1 of 20 patients with T2D and only risk factors for atherosclerosis were hospitalized with heart failure over 4 years of follow-up. Furthermore, there is substantial heterogeneity of risk in patients with T2D without known CVD. In the SAVOR-TIMI 53 …

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卡那列净

文章，见p323。心血管疾病占2型糖尿病（T2D）患者所见的过多死亡的大部分。1因此，为了改善这一人群的临床结局，临床医生应着重于降低其后发生心血管事件风险的治疗方法。在过去的两年中，随机对照临床试验确定了几种可降低患有心血管疾病（CVD）或处于心血管疾病高风险（CVD）的T2D患者的心血管事件的药物，这种作用可能与降低血糖有关，这最初是针对它们的适应症。 2–5发现其中一种疗法（依法格列净），一种钠葡萄糖共转运蛋白2抑制剂（SGLT-2i）可以降低重大不良心血管事件（MACE），心血管死亡，因心力衰竭住院的风险，2然而，尚不知道SGLT-2i是否也可以降低T2D但未建立CVD的低危人群中的心血管事件。大多数T2D患者尚未建立CVD。6尽管总体而言，其不良心脏事件的风险低于T2D和CVD患者，但该人群终生仍会遭受未来缺血事件的巨大风险。7此外，心血管事件可能不是由缺血直接介导的疾病（如心力衰竭）也很重要，并在有或没有建立CVD的患者中发生。7在对全球REACH登记册（减少持续性血栓形成）的分析中，约有20000例患者T2D 在20年的随访中，只有20名T2D患者和仅有动脉粥样硬化危险因素的1例因心力衰竭住院。此外，在没有已知CVD的T2D患者中，风险存在很大的异质性。在SAVOR-TIMI 53中...